Unknown Individual – Hepatology Physician, NPI 1356458418

Hepatology Physician

Unknown Individual is a healthcare provider. based in San antonio, Texas. specializing in Hepatology Physician. They hold a License No. L4958 (TX). The NPI Number for Unknown Individual is 1356458418

Main info

Organization

Inactive

27 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1356458418

Phone

(210) 358-4000

Address

4502 MEDICAL DR

Deactivation Date

13 September 2023

Doctor Profile

Medical School Name

MEDICAL COLLEGE OF WISCONSIN

Secondary Phone

2103584000

Graduation Year

1999 (27 years ago)

PAC ID

9032267257

Group Practice PAC ID

0042128548

Professional Enrollment ID

I20090428000191

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience24

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

4502 MEDICAL DR
SAN ANTONIO, TX 782294402
Phone: (210) 358-4000
Fax: (210) 257-1428
Type: Location
7703, Floyd Curl Drive, South Texas Medical Center, San Antonio, Bexar County, Texas, 78229, United States
MC 7977
SAN ANTONIO, TX 782293901
Phone: (210) 257-1400
Fax: (210) 257-1428
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.

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 78229)

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Provider's Procedures

Unknown Individual performs procedures in Hepatology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
GASTROENTEROLOGY	TX	43235	Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope	13	13

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: 0042128548View full group profile

Name	Specialty	State
NNENNA AWAGU (CRNA)	-	TX
ELIZABETH A HALLMAN (ACNP-BC)	-	TX
EDWARD J ZAYAC (O.D.)	-	TX
ROBERT RICHARD LEVERENCE (MD)	Internal Medicine, Hospitalist	TX
JAMES PAINE (M.D.)	-	TX
Unknown Individual	-	TX
DR. MATTHEW JAMES BUTLER (M.D.)	Internal Medicine, Hematology/Oncology	TX
MOHIUDDIN RASEL	-	TX
DR. ANAND B KARNAD (M.D.)	Hematology/Oncology, Medical Oncology	TX
DR. KAREN C. DIAZ (MD)	-	TX