Unknown Individual – Family Medicine Physician, NPI 1043221054

Unknown Individual is a healthcare provider. based in Canyon, Texas. specializing in Family Medicine Physician. They hold a License No. F9508 (TX). The NPI Number for Unknown Individual is 1043221054

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043221054
Phone
(806) 655-2104
Address
911 23RD ST
Deactivation Date
4 September 2024

Doctor Profile

Medical School Name
TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
Secondary Phone
8066552104
Graduation Year
1981 (45 years ago)
PAC ID
7315837382
Group Practice PAC ID
9133341795
Professional Enrollment ID
I20080207000405
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

  • CareXpress Urgent Care, 911, 23rd Street, Canyon, Randall County, Texas, 79015, United States

    CANYON, TX 790154600

    Phone: (806) 655-2104

    Fax: (806) 655-0522

    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)

CMS reports 27 Open Payments records for all available years, with a total value of $508.

Total Amount is formed as General ($508) + Research ($0) + Ownership ($0) = $508.

Last reported payment date: 2024-08-27 • Largest payer in this snapshot: Abbott Laboratories ($263).

Total Amount

$508

General + Research + Ownership

Payments

27

Total payment records

General Amount

$508

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-27

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99490Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month704101$0
95165Professional service for preparation and provision of 1 or more antigens62011$0
99214Established patient office or other outpatient visit, 30-39 minutes382188$0
99215Established patient office or other outpatient visit, 40-54 minutes199146$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit109109$0
View full utilization report →

Insurance plans in this area (ZIP 79015)

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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 MEDICINETX90670Pneumococcal vaccine for injection into muscle2828

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: 9133341795View full group profile
NameSpecialtyState
Nurse PractitionerTX
Family PracticeTX
Nurse PractitionerTX
Nurse PractitionerTX
Nurse PractitionerTX
Nurse PractitionerTX
Family PracticeTX
Physician AssistantTX
Nurse PractitionerTX
Nurse PractitionerTX

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1043221054 for Unknown Individual, then check state licensing separately.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Canyon, Texas in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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