Unknown Individual – Diagnostic Radiology Physician, NPI 1508847708

Unknown Individual is a healthcare provider. based in La grange, Texas. specializing in Diagnostic Radiology Physician. They hold a License No. D8084 (TX). The NPI Number for Unknown Individual is 1508847708

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1508847708
Phone
Not provided
Address
335 CLUB VIEW DR
Deactivation Date
4 March 2022

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Secondary Phone
86621837545002
Graduation Year
1967 (59 years ago)
PAC ID
7810884020
Group Practice PAC ID
2062734858
Professional Enrollment ID
I20040302001226
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

  • 335 CLUB VIEW DR

    LA GRANGE, TX 789455709

    Phone:

    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.

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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 Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYTX71010X-ray of chest, 1 view, front283145
DIAGNOSTIC RADIOLOGYTX71250CT scan chest1111

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: 2062734858View full group profile
NameSpecialtyState
Diagnostic RadiologyCA
-FL
-OH
Diagnostic RadiologyTX
Diagnostic RadiologyKS
-ID
Diagnostic RadiologyNJ
Diagnostic RadiologyTX
Diagnostic RadiologyAZ
Diagnostic RadiologyHI

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1508847708 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Diagnostic Radiology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to La Grange, Texas in the data we show; additional addresses may exist on the full record.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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