Unknown Individual – Family Medicine Physician, NPI 1497782544

Unknown Individual is a healthcare provider. based in Dover, Tennessee. specializing in Family Medicine Physician. They hold a License No. MD0000005579 (TN). The NPI Number for Unknown Individual is 1497782544

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1497782544
Phone
(931) 232-3905
Address
1020 MOORE RD
Deactivation Date
7 August 2024

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Secondary Phone
9315021286
Graduation Year
1965 (61 years ago)
PAC ID
2264440528
Group Practice PAC ID
0547276917
Professional Enrollment ID
I20060328000356
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

  • Moore Road, Silverton Estates, Silverton, Toms River, Ocean County, New Jersey, 08753, United States

    DOVER, TN 370583750

    Phone: (931) 232-3905

    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 37058)

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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 MEDICINETN71010X-ray of chest, 1 view, front5041

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: 0547276917View full group profile
NameSpecialtyState
Physician AssistantTN
G A S T R O E N T E R O L O G YTN
General SurgeryGA
General SurgeryPA
Nurse PractitionerTN
Vascular Surgery, General SurgeryTN
Physician AssistantTN
General SurgeryTN
-TN
Nurse PractitionerTN

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1497782544 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Dover, Tennessee for Unknown Individual; download NPPES for the complete set.
What if Dover, Tennessee seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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