Unknown Individual – Family Medicine Physician, NPI 1114960671

Unknown Individual is a healthcare provider. based in Lexington, Tennessee. specializing in Family Medicine Physician. They hold a License No. 1417 (TN). The NPI Number for Unknown Individual is 1114960671

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114960671
Phone
(731) 968-4477
Address
PO BOX 457
Deactivation Date
24 April 2024

Doctor Profile

Medical School Name
R FRANKLIN UNIVERSITY OF MED & SCI/CHICAGO MEDICAL SCHOOL
Secondary Phone
8642231468
Graduation Year
1983 (43 years ago)
PAC ID
9537067871
Group Practice PAC ID
6204731300
Professional Enrollment ID
I20131022000016
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

  • PO BOX 457

    LEXINGTON, TN 383510457

    Phone: (731) 968-4477

    Fax: (731) 968-3751

    Type: Mailing

  • 249, West Church Street, Lexington, Henderson County, West Tennessee, Tennessee, 38351, United States

    LEXINGTON, TN 383512013

    Phone: (731) 968-4477

    Fax: (731) 968-3751

    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 38351)

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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: 6204731300View 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 1114960671 for Unknown Individual.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
How should patients interpret Unknown Individual's specialty?
The extract shows Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Lexington, Tennessee in the same public data insurers reference.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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