Unknown Individual – Family Medicine Physician, NPI 1669567723

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Greenville, Texas. specializing in Family Medicine Physician. They hold a License No. F3117 (TX). The NPI Number for Unknown Individual is 1669567723

Main info

Organization

Inactive

48 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1669567723

Phone

(903) 454-3025

Address

PO BOX 1908

Deactivation Date

18 September 2025

Doctor Profile

Medical School Name

EASTERN VIRGINIA MEDICAL SCHOOL

Secondary Phone

9037712846

Graduation Year

1978 (48 years ago)

PAC ID

3072556190

Group Practice PAC ID

9638307648

Professional Enrollment ID

I20050608001090

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

Greenville Post Office, 600, West Washington Street, Downtown, Greenville, Greenville County, South Carolina, 29602, United States
GREENVILLE, TX 754031908
Phone: (903) 454-3025
Fax: (903) 450-1408
Type: Mailing
4311, Wesley Street, Greenville, Hunt County, Texas, 75401, United States
GREENVILLE, TX 754015639
Phone: (903) 455-5958
Fax: (903) 454-4514
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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
99213	Established patient office or other outpatient visit, 20-29 minutes	21	18	$0

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Insurance plans in this area (ZIP 75403)

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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: 9638307648View full group profile

Name	Specialty	State
GEORGE ALLEN III FRITTS (D.O.)	Family Practice	TX
DR. JOBETH AUGUSTYNIAK (D.O.)	Family Practice	TX
DR. PAUL ALAN MABRY (M.D.)	-	NY
LAUREN MARIKA FLEWELEN (MD)	Family Practice	WI
DR. JONATHAN WAYNE WILLIAMS (MD)	-	TX
AHMED SHEIKH (DO)	Family Practice	TX
NISHANT ABRAHAM KOSHY	Family Practice	TX