Unknown Individual – Family Medicine Physician, NPI 1063641884
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
South Utica Avenue, Kendall Whitter-West, Tulsa, Tulsa County, Oklahoma, 74114, United States
TULSA, OK 741045346
Phone: (918) 748-7557
Fax: (918) 403-0383
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 15 Open Payments records for all available years, with a total value of $550.
Total Amount is formed as General ($550) + Research ($0) + Ownership ($0) = $550.
Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Insulet Corporation ($315).
Total Amount
$550
General + Research + Ownership
Payments
15
Total payment records
General Amount
$550
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Insulet Corporation | $315 |
| Boehringer Ingelheim Pharmaceuticals, Inc. | $56 |
| Novo Nordisk Inc | $55 |
| Mylan Specialty L.P. | $34 |
| Amgen Inc. | $33 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 289 | 219 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 198 | 180 | $0 |
| 87804 | Detection test by immunoassay with direct visual observation for influenza virus | 138 | 67 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 118 | 93 | $0 |
| 81003 | Automated urinalysis test | 115 | 106 | $0 |
Insurance plans in this area (ZIP 74104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | KS | |
| Nurse Practitioner | OK | |
| Nurse Practitioner | KS | |
| Physician Assistant | OK | |
| Family Practice | OK | |
| - | OK | |
| - | OK | |
| Emergency Medicine | OK | |
| Nurse Practitioner | OK | |
| Physician Assistant | OK |
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