Unknown Individual – Medical Physician Assistant, NPI 1417956574

Unknown Individual is a healthcare provider. based in Corpus christi, Texas. specializing in Medical Physician Assistant. They hold a License No. PA02106 (TX). The NPI Number for Unknown Individual is 1417956574

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417956574
Phone
(361) 888-6782
Address
2502 MORGAN AVE
Deactivation Date
23 October 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3618833683
Graduation Year
1982 (44 years ago)
PAC ID
3779620026
Group Practice PAC ID
6406921782
Professional Enrollment ID
I20091020000149
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

  • 2502, Morgan Avenue, Corpus Christi, Nueces County, Texas, 78405, United States

    CORPUS CHRISTI, TX 784051807

    Phone: (361) 888-6782

    Fax: (361) 888-6788

    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)

CMS reports 23 Open Payments records for all available years, with a total value of $535.

Total Amount is formed as General ($535) + Research ($0) + Ownership ($0) = $535.

Last reported payment date: 2024-11-12 • Largest payer in this snapshot: SANOFI-AVENTIS U.S. LLC ($268).

Total Amount

$535

General + Research + Ownership

Payments

23

Total payment records

General Amount

$535

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-12

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
95004Test for allergy using allergenic extract2,15527$0
96900Application of ultraviolet light to skin33012$0
99214Established patient office or other outpatient visit, 30-39 minutes302146$0
99213Established patient office or other outpatient visit, 20-29 minutes6047$0
99204New patient office or other outpatient visit, 45-59 minutes3333$0
View full utilization report →

Insurance plans in this area (ZIP 78405)

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Provider's Procedures

Unknown Individual performs procedures in Medical Physician Assistant. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICIAN ASSISTANTTX94060Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration5848

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: 6406921782View full group profile
NameSpecialtyState
Pediatric Medicine, Allergy/ImmunologyTX
-TX
Nurse PractitionerTX

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1417956574.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Medical Physician Assistant for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Corpus Christi, Texas in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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