Unknown Individual – Diagnostic Radiology Physician, NPI 1669676243

Diagnostic Radiology Physician

Unknown Individual is a healthcare provider. based in Eden prairie, Minnesota. specializing in Diagnostic Radiology Physician. They hold a License No. N6949 (TX). The NPI Number for Unknown Individual is 1669676243

Main info

Organization

Inactive

22 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1669676243

Phone

(952) 595-1301

Address

11995 SINGLETREE LN

Deactivation Date

28 January 2022

Doctor Profile

Medical School Name

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Secondary Phone

9525951100

Graduation Year

2004 (22 years ago)

PAC ID

8527256361

Group Practice PAC ID

6204838766

Professional Enrollment ID

I20101221000890

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

11995, Singletree Lane, Eden Prairie, Hennepin County, Minnesota, 55344, United States
SUITE 500
EDEN PRAIRIE, MN 553445347
Phone: (952) 595-1301
Fax: (612) 294-4903
Type: Mailing
411, Gully Ranch Court, Dickinson, Galveston County, Texas, 77539, United States
DICKINSON, TX 775397279
Phone: (952) 595-1100
Fax: (612) 294-4903
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 55344)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
DIAGNOSTIC RADIOLOGY	TX	71010	X-ray of chest, 1 view, front	615	545
DIAGNOSTIC RADIOLOGY	TX	71250	CT scan chest	12	12
DIAGNOSTIC RADIOLOGY	TX	73562	X-ray of knee, 3 views	44	40
DIAGNOSTIC RADIOLOGY	TX	74177	CT scan of abdomen and pelvis with contrast	36	36

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: 6204838766View full group profile

Name	Specialty	State
DR. MICHAEL ANTHONY TODORA (MD)	Diagnostic Radiology	TX
DR. KAREN W. SIMMONS (MD)	Diagnostic Radiology	TX
SUSAN S. PINERO (M.D.)	Diagnostic Radiology	MN
FOZAIL IMRAN ALVI (MD)	Diagnostic Radiology	MN
MR. MUZAMMIL ZAKKIR HANIF	Diagnostic Radiology	MN
ROBERT COLLINS WATSON	Diagnostic Radiology	AL
HARISHA KOMMANA (MD)	Diagnostic Radiology	NY
DR. ELIZABETH K TIEMAN (M.D.)	-	MN
LAWRENCE WILLIAM KALER (MD)	Diagnostic Radiology	MN
ERIC ALEXANDER CROWDER (M.D.)	-	MN