Unknown Individual – Family Medicine Physician, NPI 1629078464

Unknown Individual is a healthcare provider. based in Grapevine, Texas. specializing in Family Medicine Physician. They hold a License No. L0903 (TX). The NPI Number for Unknown Individual is 1629078464

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629078464
Phone
(817) 421-2714
Address
3105 IRA E WOODS AVE
Deactivation Date
2 October 2025

Doctor Profile

Medical School Name
BAYLOR COLLEGE OF MEDICINE
Secondary Phone
9724846435
Graduation Year
1992 (34 years ago)
PAC ID
0648203166
Group Practice PAC ID
9739260019
Professional Enrollment ID
I20050915000335
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Ira E Woods Avenue, Grapevine, Tarrant County, Texas, 76051, United States

    SUITE 120

    GRAPEVINE, TX 760513891

    Phone: (817) 421-2714

    Fax: (817) 421-2717

    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 1 Open Payments records for all available years, with a total value of $121.

Total Amount is formed as General ($121) + Research ($0) + Ownership ($0) = $121.

Last reported payment date: 2024-10-17 • Largest payer in this snapshot: Gilead Sciences, Inc. ($121).

Total Amount

$121

General + Research + Ownership

Payments

1

Total payment records

General Amount

$121

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-17

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Gilead Sciences, Inc.$121
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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76051)

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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: 9739260019View full group profile

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1629078464.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Grapevine?
Unknown Individual currently maps to Grapevine, Texas in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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