Unknown Individual – Emergency Medicine Physician, NPI 1114138419

Unknown Individual is a healthcare provider. based in Temple, Texas. specializing in Emergency Medicine Physician. They hold a License No. 57012076 (OH). The NPI Number for Unknown Individual is 1114138419

Main info

Organization
Inactive
20 Years Of Experience
Name
Unknown Individual
NPI
1114138419
Phone
Not provided
Address
2401 S 31ST ST
Deactivation Date
15 April 2021

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Secondary Phone
2817893400
Graduation Year
2006 (20 years ago)
PAC ID
0345305652
Group Practice PAC ID
1355665795
Professional Enrollment ID
I20090220000411
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

  • Baylor Scott & White Medical Center - Temple, 2401, South 31st Street, Temple, Bell County, Texas, 76508, United States

    TEMPLE, TX 765080001

    Phone:

    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 76508)

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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: 1355665795View full group profile
NameSpecialtyState
Nurse PractitionerTX
Family PracticeTN
Emergency MedicineNY
Emergency MedicineTX
Nurse PractitionerCA
Emergency MedicineTX
Emergency MedicineOH
-TX
Emergency MedicineTX
Family PracticeTX

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1114138419 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Texas is Unknown Individual registered?
Use Temple, Texas as the headline location for Unknown Individual here.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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