Unknown Individual – Diagnostic Radiology Physician, NPI 1194764787

Unknown Individual is a healthcare provider. based in Plano, Texas. specializing in Diagnostic Radiology Physician. They hold a License No. J6571 (TX). The NPI Number for Unknown Individual is 1194764787

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1194764787
Phone
(972) 596-4033
Address
3801 W 15TH ST STE C
Deactivation Date
13 June 2022

Doctor Profile

Medical School Name
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
8662576864
Graduation Year
1993 (33 years ago)
PAC ID
6305750688
Group Practice PAC ID
7517853351
Professional Enrollment ID
I20031119000675
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

  • 3801 W 15TH ST STE C

    PLANO, TX 750757775

    Phone: (972) 596-4033

    Type: Location

  • Greenville Post Office, 600, West Washington Street, Downtown, Greenville, Greenville County, South Carolina, 29602, United States

    GREENVILLE, TX 75403

    Phone: (800) 945-2455

    Fax: (903) 453-2541

    Type: Mailing

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.

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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 75075)

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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: 7517853351View full group profile
NameSpecialtyState
Diagnostic RadiologyTX
Diagnostic RadiologyTX
Diagnostic RadiologyTX
-TX
Diagnostic RadiologyLA
Diagnostic RadiologyTX
Diagnostic RadiologyTX
Diagnostic RadiologyTX
Diagnostic RadiologyTX
Diagnostic RadiologyTX

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1194764787.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Plano, Texas in the same public data insurers reference.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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