Unknown Individual – Interventional Cardiology Physician, NPI 1083645576

Interventional Cardiology Physician

Unknown Individual is a healthcare provider. based in Pearland, Texas. specializing in Interventional Cardiology Physician. They hold a License No. F1364 (TX). The NPI Number for Unknown Individual is 1083645576

Main info

Organization

Inactive

48 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1083645576

Phone

(713) 442-0000

Address

11511 SHADOW CREEK PKWY

Deactivation Date

7 February 2024

Doctor Profile

Medical School Name

BAYLOR COLLEGE OF MEDICINE

Secondary Phone

7134424849

Graduation Year

1978 (48 years ago)

PAC ID

6608063839

Group Practice PAC ID

9739093527

Professional Enrollment ID

I20101214000268

Contacts

Secure Messaging

bbarnum484@direct.kelsey-seybold.com

FHIR Endpoint

https://ssrx.ksnet.com/FhirProxy/api/FHIR/DSTU2/

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience24

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

Shadow Creek Parkway, Pearland, Brazoria County, Texas, 77047-4593, United States
PEARLAND, TX 775847298
Phone: (713) 442-0000
Type: Mailing
Spencer R. Berthelsen, M.D., Main Campus, 2727, West Holcombe Boulevard, Houston, Harris County, Texas, 77025, United States
HOUSTON, TX 770251669
Phone: (713) 442-0000
Type: Location
1010 S Ponds Dr
Webster, TX 775981409
Phone: (713) 442-4300
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 77584)

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Provider's Procedures

Unknown Individual performs procedures in Interventional Cardiology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)	TX	93010	Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	24	24

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: 9739093527View full group profile

Name	Specialty	State
JOSHUA E LEIF (O.D.)	-	TX
MELANIE EHNI MOUZOON (MD)	-	TX
MARILYNN TEDJA (MD)	Hospitalist, Internal Medicine	TX
MARIANNA KARPINOS (MD)	N E U R O L O G Y	TX
DR. ROSELLA DIAZ CREED (MD)	D E R M A T O L O G Y	TX
ALI JAFAR S AL-HIMYARY (MD)	Critical Care (Intensivists), Internal Medicine, Pulmonary Disease	TX
JAYNA PATEL (ACNPC-AG)	-	TX
EMMA LEATHAM (PA-C)	Physician Assistant	TX
DORCAS PHILIPS (MD)	Family Practice	TX
MEAGHAN MAUREEN BIRCH (PA-C)	Physician Assistant	MA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?

Administrative and clinical systems typically use NPI 1083645576 for Unknown Individual.

Does inactive mean outdated data for Unknown Individual?

Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Interventional Cardiology Physician. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Pearland, Texas in registry-derived data.

Why is information missing for Unknown Individual?

Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.