Unknown Individual – Family Medicine Physician, NPI 1710909593

Unknown Individual is a healthcare provider. based in Tulsa, Oklahoma. specializing in Family Medicine Physician. They hold a License No. 16665 (OK). The NPI Number for Unknown Individual is 1710909593

Main info

Organization
Inactive
39 Years Of Experience
Name
Unknown Individual
NPI
1710909593
Phone
(918) 481-8100
Address
7125 S. BRADEN AVE.
Deactivation Date
10 July 2024

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Secondary Phone
9187592200
Graduation Year
1987 (39 years ago)
PAC ID
5799755914
Group Practice PAC ID
4587928817
Professional Enrollment ID
I20061114000493
Data current as of
19 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

  • 7125, South Braden Avenue East, Tulsa, Oklahoma, 74136, United States

    TULSA, OK 74136

    Phone: (918) 481-8100

    Fax: (918) 481-8195

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $31.

Total Amount is formed as General ($31) + Research ($0) + Ownership ($0) = $31.

Last reported payment date: 2023-08-17 • Largest payer in this snapshot: ABBVIE INC. ($31).

Total Amount

$31

General + Research + Ownership

Payments

1

Total payment records

General Amount

$31

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-08-17

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$31
View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
96160Administration and interpretation of patient-focused health risk assessment16385$0
99214Established patient office or other outpatient visit, 30-39 minutes13983$0
99490Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month9963$0
99213Established patient office or other outpatient visit, 20-29 minutes9754$0
99211Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional7152$0
View full utilization report →

Insurance plans in this area (ZIP 74136)

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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: 4587928817View full group profile

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1710909593 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Tulsa, Oklahoma?
If you are local to Tulsa, Oklahoma, Unknown Individual may be relevant to your search.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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