Unknown Individual – Family Medicine Physician, NPI 1053306415

Unknown Individual is a healthcare provider. based in Groesbeck, Texas. specializing in Family Medicine Physician. They hold a License No. D6934 (TX). The NPI Number for Unknown Individual is 1053306415

Main info

Organization
Inactive
56 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053306415
Phone
(254) 729-3411
Address
801 MCCLINTIC DR
Deactivation Date
27 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2547293281
Graduation Year
1970 (56 years ago)
PAC ID
5193885838
Group Practice PAC ID
9032103700
Professional Enrollment ID
I20081125000393
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

  • McClintic Drive, Groesbeck, Limestone County, Texas, 76642, United States

    GROESBECK, TX 766422130

    Phone: (254) 729-3411

    Fax: (254) 729-3258

    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 76642)

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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: 9032103700View full group profile
NameSpecialtyState
Family PracticeTX
Nurse PractitionerTX
-TX
Family PracticeTX
P S Y C H I A T R YTX
Physician AssistantTX
Nurse PractitionerTX
-TX
Family PracticeTX
Emergency MedicineFL

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1053306415.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Groesbeck, Texas in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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