Unknown Individual – Internal Medicine Physician, NPI 1417984113

Internal Medicine Physician

Unknown Individual is a healthcare provider. based in Chickasha, Oklahoma. specializing in Internal Medicine Physician. They hold a License No. 9935 (OK). The NPI Number for Unknown Individual is 1417984113

Main info

Organization

Inactive

54 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1417984113

Phone

(405) 224-2100

Address

2100 W IOWA AVE

Deactivation Date

30 October 2025

Doctor Profile

Medical School Name

UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE

Secondary Phone

4052242100

Graduation Year

1972 (54 years ago)

PAC ID

5597792275

Group Practice PAC ID

0648175778

Professional Enrollment ID

I20091201000305

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

2100, West Iowa Avenue, Chickasha, Grady County, Oklahoma, 73018, United States
SUITE A
CHICKASHA, OK 730182736
Phone: (405) 224-2100
Fax: (405) 779-2808
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 73018)

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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: 0648175778View full group profile

Name	Specialty	State
MIGUEL RODRIGUEZ (M.D.)	-	OK
MRS. ABBY MARIE HOUSMAN (D.O.)	Family Practice	OK
KAYLA ZABALA	Emergency Medicine	OK
DEACON VICE (D.O.)	Emergency Medicine	OK
DR. BRUCE LEON STORMS (M.D.)	-	OK
KEVIN ANDERSON (D.O.)	Family Practice	OK
ROBERT T BUCHANAN (MD)	General Surgery	TX
DR. THOMAS ALAN JARVIS (D.O.)	Family Practice, Emergency Medicine	OK
JACOB QUE BYERS (M.D.)	Pain Management	OK
MRS. AMY KATHLEEN FERRELL (FNP-C)	Nurse Practitioner	OK

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?

NPI 1417984113 is assigned to Unknown Individual under the national enumeration system.

Should I trust care from Unknown Individual if status is inactive?

An inactive NPI does not by itself prove someone stopped practicing — check other sources.

What does Unknown Individual treat or focus on?

Patients typically see Unknown Individual under the specialty Internal Medicine Physician. Clinical services aligned with this taxonomy classification.

Does Unknown Individual practice in Oklahoma?

You will see Chickasha, Oklahoma on file for Unknown Individual alongside any extra practice locations.

How can I contact Unknown Individual?

Phone or fax may appear on the official NPI record when supplied — verify before relying on them.