Unknown Individual – Diagnostic Radiology Physician, NPI 1538165790

Unknown Individual is a healthcare provider. based in Beaumont, Texas. specializing in Diagnostic Radiology Physician. They hold a License No. H5393 (TX). The NPI Number for Unknown Individual is 1538165790

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1538165790
Phone
(409) 838-4772
Address
25 N 11TH ST
Deactivation Date
18 December 2025

Doctor Profile

Medical School Name
VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
Secondary Phone
4092125000
Graduation Year
1977 (49 years ago)
PAC ID
0244245470
Group Practice PAC ID
2163799685
Professional Enrollment ID
I20091116000618
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

  • 25, North 11th Street, Beaumont, Jefferson County, Texas, 77702, United States

    BEAUMONT, TX 777022224

    Phone: (409) 838-4772

    Fax: (409) 838-6134

    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.

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 77702)

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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, front14571138
DIAGNOSTIC RADIOLOGYTX73110X-ray of wrist, minimum of 3 views2018
DIAGNOSTIC RADIOLOGYTX73562X-ray of knee, 3 views3125
DIAGNOSTIC RADIOLOGYTX73630X-ray of foot, minimum of 3 views8372
DIAGNOSTIC RADIOLOGYTX74177CT scan of abdomen and pelvis with contrast171167

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: 2163799685View full group profile
NameSpecialtyState
TROY A. JONES (M.D.)
Diagnostic RadiologyTX
DR. PHILIP BEUCHERT (M.D.)
Diagnostic RadiologyMN
GREGORY C. DIAZ (M.D.)
Diagnostic RadiologyTX
MR. EVERARDO JR. FLORES (M.D.)
Diagnostic RadiologyTX
DR. ROBERT STANLEY III MORRISON (M.D.)
Diagnostic RadiologyTX

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1538165790 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Beaumont, Texas in our summary view.
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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