Unknown Individual – Family Medicine Physician, NPI 1558341396

Unknown Individual is a healthcare provider. based in Oklahoma city, Oklahoma. specializing in Family Medicine Physician. They hold a License No. 1971 (OK). The NPI Number for Unknown Individual is 1558341396

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1558341396
Phone
(918) 540-7788
Address
5300 N INDEPENDENCE AVE
Deactivation Date
23 September 2021

Doctor Profile

Medical School Name
OKLAHOMA STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
9185407788
Graduation Year
1978 (48 years ago)
PAC ID
5890608046
Group Practice PAC ID
2365408465
Professional Enrollment ID
I20050927000087
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

  • 5300, North Independence Avenue, Oklahoma City, Oklahoma County, Oklahoma, 73112, United States

    280

    OKLAHOMA CITY, OK 731125556

    Phone: (918) 540-7788

    Fax: (918) 540-7786

    Type: Mailing

  • 310, 2nd Avenue Southwest, Miami, Ottawa County, Oklahoma, 74354, United States

    STE. 203

    MIAMI, OK 743546743

    Phone: (918) 540-7788

    Fax: (918) 540-7786

    Type: Location

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 73112)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEOK20610Aspiration and/or injection of large joint or joint capsule11263
FAMILY MEDICINEOK90670Pneumococcal vaccine for injection into muscle1919

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: 2365408465View full group profile
NameSpecialtyState
LIMEI YANG (MD)
P S Y C H I A T R YOK
DR. KELSEY KEOPPEL (DO)
-OK
STEPHANIE ARLENE WHATLEY (P.A.)
Physician AssistantOK
DR. KIMBERLY S SMITH (M.D.)
Orthopedic SurgeryOK
MRS. CHELSEA RENEE LOWERY (DO)
-OK
LUKE R LEMING (DO)
Family Practice, General Surgery, Osteopathic Manipulative MedicineOK
MRS. KRISTY RENEA BAKER (ARNP)
-OK
DR. JUSTIN ANDRE NALAGAN (M.D.)
H O S P I T A L I S TOK
SAMER HASSAN (M.D.)
H E M A T O L O G Y/ O N C O L O G YOK
CHARLES E BRYANT (MD)
-OK

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1558341396.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Oklahoma City, Oklahoma for Unknown Individual; expand the address list for detail.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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