Unknown Individual – Geriatric Medicine (Internal Medicine) Physician, NPI 1144237942

Geriatric Medicine (Internal Medicine) Physician

Unknown Individual is a healthcare provider. based in Beaumont, Texas. specializing in Geriatric Medicine (Internal Medicine) Physician. They hold a License No. D8455 (TX). The NPI Number for Unknown Individual is 1144237942

Main info

Organization

Inactive

55 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1144237942

Phone

(409) 898-2994

Address

755 N 11TH ST

Deactivation Date

12 January 2021

Doctor Profile

Medical School Name

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Secondary Phone

4098982994

Graduation Year

1971 (55 years ago)

PAC ID

5496888596

Group Practice PAC ID

9032195789

Professional Enrollment ID

I20100920000926

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

755, North 11th Street, Beaumont, Jefferson County, Texas, 78734, United States
SUITE P-5200
BEAUMONT, TX 777021501
Phone: (409) 898-2994
Fax: (409) 899-5542
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 77702)

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Provider's Procedures

Unknown Individual performs procedures in Geriatric Medicine (Internal Medicine) Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
INTERNAL MEDICINE	TX	90670	Pneumococcal vaccine for injection into muscle	78	78

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: 9032195789View full group profile

Name	Specialty	State
MRS. TARA M. HOLDER (APRN, ENP, FNP)	-	TX
DR. MUSTAFA IBRAHIM MUSA (M.D.)	Internal Medicine	TX
DR. MARIA SUSAN BLAHEY (MD)	Family Practice, Hospice/Palliative Care	TX
CHAD W HAMMETT (M.D.)	Family Practice	TX
KRISTEN LEANNE BLACKWELL (FNP-C)	Nurse Practitioner	TX
RAWAN MUSTAFA MUSA (MD)	Internal Medicine	TX
MR. JAMES MATTHEW MORRISON (APRN, FNP-C, CEN)	Nurse Practitioner	TX
DR. SANTOS MARCELO SOBERON (M.D.)	Internal Medicine	TX
MISS COURTNEY MARIE GUIDRY (PA-C)	Physician Assistant	TX
DR. GWENDOLYN L LAVALAIS (M.D.)	-	TX

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?

Yes — Unknown Individual has NPI 1144237942 on file in the registry.

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 Geriatric Medicine (Internal Medicine) Physician in the directory — Clinical services aligned with this taxonomy classification.

What locale is associated with Unknown Individual?

Directory geography for Unknown Individual centers on Beaumont, Texas.

What does 2 location(s) imply?

2 practice locations appear in the available data.