Unknown Individual – Family Medicine Physician, NPI 1619103124

Unknown Individual is a healthcare provider. based in Midland, Texas. specializing in Family Medicine Physician. They hold a License No. Q5561 (TX). The NPI Number for Unknown Individual is 1619103124

Main info

Organization
Inactive
17 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619103124
Phone
(432) 686-6600
Address
4214 ANDREWS HWY
Deactivation Date
28 December 2022

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
Secondary Phone
3615262321
Graduation Year
2009 (17 years ago)
PAC ID
4587964994
Group Practice PAC ID
1153216783
Professional Enrollment ID
I20151207002301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Midland Memorial Hospital West Campus, 4214, Andrews Highway, Radio Plaza, Midland, Midland County, Texas, 79703, United States

    SUITE 240

    MIDLAND, TX 797034822

    Phone: (432) 686-6600

    Type: Mailing

  • 3620, North Big Spring Street, Homestead, Downtown Midland Management District, Midland, Midland County, Texas, 79705, United States

    MIDLAND, TX 797054505

    Phone: (432) 682-7473

    Type: Location

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 79703)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINETX83036Hemoglobin A1C level2520
FAMILY MEDICINETX90670Pneumococcal vaccine for injection into muscle1111

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: 1153216783View full group profile
NameSpecialtyState
DR. PHILLIP JACKSON (M.D.)
-TX
DR. MICHAEL W. PETERSON (MD)
-TX
COLE SEATON (DO)
-TX
MICHAEL TODD STAFFORD (M.D.)
-TX
DR. BRETT ZIMMERMAN (MD)
-TX
MS. DEBRA KAY STAPLES (RN, NP-C (FNP))
Nurse PractitionerTX
MR. JOHN EMERSON WINEMAN (PA-C)
Physician AssistantTX
DR. AMBER LEE NEUGEBAUER (DO)
-TX
DR. RUSSELL MASCARENHAS (M.D.)
Internal Medicine, Family PracticeTX
JOHN VOSBURG WELSH (M.D.)
Emergency MedicineTX

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1619103124.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Midland, Texas. Check all listed addresses for suites or satellite offices.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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