Unknown Individual – Obstetrics & Gynecology Physician, NPI 1124091178

Obstetrics & Gynecology Physician

Unknown Individual is a healthcare provider. based in Corpus christi, Texas. specializing in Obstetrics & Gynecology Physician. They hold a License No. G0857 (TX). The NPI Number for Unknown Individual is 1124091178

Main info

Organization

Inactive

52 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124091178

Phone

(361) 851-5000

Address

7121 S P I D

Deactivation Date

10 May 2023

Doctor Profile

Medical School Name

UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO

Secondary Phone

3618515000

Graduation Year

1974 (52 years ago)

PAC ID

9638108954

Group Practice PAC ID

0345206082

Professional Enrollment ID

I20110321000929

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

Provider Addresses for Unknown Individual

7121 S P I D
SUITE 302
CORPUS CHRISTI, TX 78412
Phone: (361) 851-5000
Fax: (361) 851-0590
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 78412)

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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: 0345206082View full group profile

Name	Specialty	State
MRS. LEIGHANNE GLAZENER (MD)	-	TX
CHRISTINE L CANTERBURY (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	TX
MRS. LINDA DENISE LUKER (FNP-C)	Nurse Practitioner	TX
LUANN HASSAN (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	TX
MR. JAIME PENA (MD)	-	TX
DR. BENJAMIN D SUPNET (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	TX
CECILIA YVONNE RIOS (WHCNP)	Nurse Practitioner	TX

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?

The official identifier for Unknown Individual is NPI 1124091178.

Can Unknown Individual still bill if the NPI is inactive?

Do not rely on inactive status alone — contact the provider for confirmation.

What kind of doctor is Unknown Individual?

Unknown Individual is associated with Obstetrics & Gynecology Physician in the directory — Clinical services aligned with this taxonomy classification.

Is Unknown Individual located near Corpus Christi?

Unknown Individual currently maps to Corpus Christi, Texas in this extract.

Does inactive status remove historical data?

Historical rows can remain visible after status changes — read the dates carefully.