Unknown Individual – Emergency Medicine Physician, NPI 1417065962

Unknown Individual is a healthcare provider. based in Norman, Oklahoma. specializing in Emergency Medicine Physician. They hold a License No. 1934 (OK). The NPI Number for Unknown Individual is 1417065962

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417065962
Phone
(405) 307-6918
Address
3500 HEALTHPLEX PKWY
Deactivation Date
17 April 2025

Doctor Profile

Medical School Name
OKLAHOMA STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
4053076955
Graduation Year
1978 (48 years ago)
PAC ID
1456346303
Professional Enrollment ID
I20040419001355
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • HealthPlex Parkway, Norman, Cleveland County, Oklahoma, 73069, United States

    SUITE #102

    NORMAN, OK 730729738

    Phone: (405) 307-6918

    Fax: (405) 307-6957

    Type: Location

  • Edmond Post Office, South Kelly Avenue, Edmond, Oklahoma County, Oklahoma, 73013, United States

    EDMOND, OK 730831423

    Phone: (405) 771-4844

    Fax: (405) 771-4388

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $33.

Total Amount is formed as General ($33) + Research ($0) + Ownership ($0) = $33.

Last reported payment date: 2024-08-14 • Largest payer in this snapshot: Musculoskeletal Transplant Foundation Inc. ($33).

Total Amount

$33

General + Research + Ownership

Payments

1

Total payment records

General Amount

$33

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-14

Latest reported date

Top Companies

Largest payers in this snapshot

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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 73072)

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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
EMERGENCY MEDICINEOK11042Removal of skin and tissue first 20 sq cm or less298114

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1417065962.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Norman, Oklahoma because that is what the record indicates for Unknown Individual.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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