Unknown Individual – Pain Medicine Physician, NPI 1417927823

Pain Medicine Physician

Unknown Individual is a healthcare provider. based in Tulsa, Oklahoma. specializing in Pain Medicine Physician. They hold a License No. 11837 (OK). The NPI Number for Unknown Individual is 1417927823

Main info

Organization

Inactive

49 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1417927823

Phone

(918) 619-4101

Address

4444 E 41ST ST

Deactivation Date

6 July 2022

Doctor Profile

Medical School Name

UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE

Secondary Phone

9189353240

Graduation Year

1977 (49 years ago)

PAC ID

8527969971

Group Practice PAC ID

2466648936

Professional Enrollment ID

I20040120000947

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

East 41st Street, Granite Avenue, Tulsa, Tulsa County, Oklahoma, 74135, United States
3RD FLOOR, STE A
TULSA, OK 741352527
Phone: (918) 619-4101
Fax: (918) 619-4100
Type: Location
2811, East 15th Street, Yorktown, Tulsa, Oklahoma, 74104, United States
STE 102
TULSA, OK 741045245
Phone: (918) 660-3632
Fax: (918) 660-3631
Type: Mailing

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 74135)

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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: 2466648936View full group profile

Name	Specialty	State
ZOEE ANN RAYNER (MSN, APRN, CNP)	-	OK

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?

NPI numbers are unique to each provider or organization — Unknown Individual uses 1417927823.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Pain Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

What area does Unknown Individual serve?

Unknown Individual's listing highlights Tulsa, Oklahoma; more addresses can appear in NPPES.

Is specialty guaranteed by NPI alone?

Taxonomy selections describe intent; scope of practice still follows state law.