Unknown Individual – Family Medicine Physician, NPI 1003830290

Unknown Individual is a healthcare provider. based in Odessa, Texas. specializing in Family Medicine Physician. They hold a License No. H8428 (TX). The NPI Number for Unknown Individual is 1003830290

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1003830290
Phone
(432) 335-5311
Address
701 W 5TH ST
Deactivation Date
14 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4323352222
Graduation Year
1989 (37 years ago)
PAC ID
8820085616
Group Practice PAC ID
8426044256
Professional Enrollment ID
I20040426000878
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

  • 701, West 5th Street, Scharbauer Place, Westside, Odessa, Ector County, Texas, 79763, United States

    ODESSA, TX 797634206

    Phone: (432) 335-5311

    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 79763)

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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: 8426044256View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YTX
-TX
-TX
-TX
Family Practice, Geriatric MedicineTX
Endocrinology, Internal MedicineTX
P S Y C H I A T R YTX
-TX
Family PracticeTX
Family Practice, Geriatric MedicineTX

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1003830290 when you need to reference Unknown Individual in forms, claims, or directories.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Odessa, Texas for Unknown Individual based on available NPPES addresses.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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701, West 5th Street, Scharbauer Place, Westside, Odessa, Ector County, Texas, 79763, United States
NPI: 1407845084