Unknown Individual – Surgery Physician, NPI 1679572945

Surgery Physician

Unknown Individual is a healthcare provider. based in Waco, Texas. specializing in Surgery Physician. They hold a License No. E4681 (TX). The NPI Number for Unknown Individual is 1679572945

Main info

Organization

Inactive

46 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1679572945

Phone

(254) 776-3188

Address

6600 FISH POND RD

Deactivation Date

18 October 2022

Doctor Profile

Medical School Name

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Secondary Phone

2547514242

Graduation Year

1980 (46 years ago)

PAC ID

4880791318

Group Practice PAC ID

6709002777

Professional Enrollment ID

I20100914000433

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

6600, Fish Pond Road, Waco, McLennan County, Texas, 76710, United States
SUITE 101
WACO, TX 767102581
Phone: (254) 776-3188
Fax: (254) 776-3607
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 76710)

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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: 6709002777View full group profile

Name	Specialty	State
DR. DAVID A. ROHRER (M.D.)	-	MT
DR. JACQUELINE ANN LAPPIN (M.D.)	General Surgery	TX
MRS. MARLA DAVY (FNP-C)	Nurse Practitioner	TX
CHRISTY DANIELLE HERNANDEZ	Nurse Practitioner	TX
DANA BINGHAM (NP)	Nurse Practitioner	TX
TIFFANY LINN MCCLENDON	Nurse Practitioner	TX
GLENNON RAYMOND JR. EINSPANIER (M.D.)	-	TX
DR. TED R. SMITH (M.D.)	General Surgery	TX
MATTHEW D ROBERTS (NP)	-	TX
ELIZABETH GEORGE (FNP-C)	Nurse Practitioner	TX

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?

The registry entry for Unknown Individual shows NPI 1679572945.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Surgery Physician. Clinical services aligned with this taxonomy classification.

What city is tied to Unknown Individual?

The directory associates Unknown Individual with Waco, Texas. Check all listed addresses for suites or satellite offices.

Why is information missing for Unknown Individual?

Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.