Unknown Individual – Family Medicine Physician, NPI 1811923949

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Broken arrow, Oklahoma. specializing in Family Medicine Physician. They hold a License No. 1530 (OK). The NPI Number for Unknown Individual is 1811923949

Main info

Organization

Inactive

58 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1811923949

Phone

(918) 251-2666

Address

705 W OAKLAND ST

Deactivation Date

1 March 2023

Doctor Profile

Medical School Name

AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE

Secondary Phone

9182512666

Graduation Year

1968 (58 years ago)

PAC ID

2769508076

Group Practice PAC ID

1153588355

Professional Enrollment ID

I20100923001303

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

705, West Oakland Street, Broken Arrow, Tulsa County, Oklahoma, 74012, United States
BROKEN ARROW, OK 740121656
Phone: (918) 251-2666
Fax: (918) 893-4036
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 74012)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	OK	20610	Aspiration and/or injection of large joint or joint capsule	140	47
FAMILY MEDICINE	OK	82270	Stool analysis for blood to screen for colon tumors	16	16
FAMILY MEDICINE	OK	83036	Hemoglobin A1C level	40	24

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: 1153588355View full group profile

Name	Specialty	State
DR. BRIAN CODER (D.O.)	Family Practice	OK
Unknown Individual	-	OK
JAYME KENNA MONTGOMERY (CNP)	Nurse Practitioner	OK

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1811923949.

Should I call the clinic if Unknown Individual is inactive here?

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.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Broken Arrow, Oklahoma in registry-derived data.

Can I verify credentials using only NPI?

NPI confirms identity in the directory; licensure and board certification require separate checks.