Unknown Individual – Emergency Medicine Physician, NPI 1205096427

Unknown Individual is a healthcare provider. based in Pawhuska, Oklahoma. specializing in Emergency Medicine Physician. They hold a License No. 27629 (OK). The NPI Number for Unknown Individual is 1205096427

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205096427
Phone
(918) 287-9112
Address
230 E. 5TH STREET
Deactivation Date
17 November 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9187741110
Graduation Year
2004 (22 years ago)
PAC ID
8729261920
Group Practice PAC ID
6002170578
Professional Enrollment ID
I20110325000291
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 230, East 5th Street, Pawhuska, Osage County, Oklahoma, 74056, United States

    PAWHUSKA, OK 74056

    Phone: (918) 287-9112

    Fax: (918) 287-9113

    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)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 74056)

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Provider's Procedures

Unknown Individual performs procedures in Emergency Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEOK93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report4745

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6002170578View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1205096427 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Pawhuska?
Public fields place Unknown Individual around Pawhuska, Oklahoma. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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