Unknown Individual – Endocrinology, Diabetes & Metabolism Physician, NPI 1093803942

Unknown Individual is a healthcare provider. based in Odessa, Texas. specializing in Endocrinology, Diabetes & Metabolism Physician. They hold a License No. D8161 (TX). The NPI Number for Unknown Individual is 1093803942

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093803942
Phone
(432) 335-1777
Address
701 W 5TH ST
Deactivation Date
20 March 2025

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Secondary Phone
4323352222
Graduation Year
1967 (59 years ago)
PAC ID
8426242520
Group Practice PAC ID
8426044256
Professional Enrollment ID
I20101103000143
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) 335-1777

    Fax: (432) 335-1815

    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 1 Open Payments records for all available years, with a total value of $22.

Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.

Last reported payment date: 2023-12-20 • Largest payer in this snapshot: Echosens North America, Inc. ($22).

Total Amount

$22

General + Research + Ownership

Payments

1

Total payment records

General Amount

$22

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-12-20

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.

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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Provider's Procedures

Unknown Individual performs procedures in Endocrinology, Diabetes & Metabolism Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ENDOCRINOLOGYTX83036Hemoglobin A1C level8259

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
-TX
O B S T E T R I C S/ G Y N E C O L O G YTX
-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

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1093803942.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Endocrinology, Diabetes & Metabolism Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Odessa, Texas may find Unknown Individual in results; validate coverage separately.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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