Unknown Individual – Family Medicine Physician, NPI 1629459276

Unknown Individual is a healthcare provider. based in Wichita falls, Texas. specializing in Family Medicine Physician. They hold a License No. BP10051980 (TX). The NPI Number for Unknown Individual is 1629459276

Main info

Organization
Inactive
14 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629459276
Phone
(940) 767-5145
Address
1301 3RD ST
Deactivation Date
11 March 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9407666306
Graduation Year
2012 (14 years ago)
PAC ID
4183989213
Group Practice PAC ID
9931099215
Professional Enrollment ID
I20180521000958
Data current as of
20 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

  • 1301 3RD ST

    SUITE 200

    WICHITA FALLS, TX 763012245

    Phone: (940) 767-5145

    Fax: (940) 767-3027

    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 76301)

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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: 9931099215View full group profile
NameSpecialtyState
-TX
Clinical Social WorkerTX
O B S T E T R I C S/ G Y N E C O L O G YTX
Gastroenterology, Internal MedicineTX
O B S T E T R I C S/ G Y N E C O L O G YTX
-TX
-TX
Family PracticeTX
O B S T E T R I C S/ G Y N E C O L O G YTX
Family PracticeTX

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1629459276 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Wichita Falls, Texas because that is what the record indicates for Unknown Individual.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1629459276. Always confirm identity and privileges with the practice and licensing boards.

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