Unknown Individual – Family Medicine Physician, NPI 1184626913

Unknown Individual is a healthcare provider. based in La grange, Texas. specializing in Family Medicine Physician. They hold a License No. E7689 (TX). The NPI Number for Unknown Individual is 1184626913

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1184626913
Phone
(979) 242-5878
Address
TWO ST. MARK'S PLACE #112
Deactivation Date
24 February 2022

Doctor Profile

Medical School Name
KANSAS CITY COLLEGE OF MEDICINE AND SURGERY
Secondary Phone
-
Graduation Year
1975 (51 years ago)
PAC ID
6406932763
Professional Enrollment ID
I20110216000287
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

  • TWO ST. MARK'S PLACE #112

    LA GRANGE, TX 78945

    Phone: (979) 242-5878

    Fax: (979) 242-5818

    Type: Mailing

  • TWO ST.MARK'S PLACE #112

    LA GRANGE, TX 789451256

    Phone: (979) 242-5878

    Fax: (979) 242-5818

    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.

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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 78945)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINETX93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report3533

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1184626913 on file in the registry.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Texas is Unknown Individual registered?
Use La Grange, Texas as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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