Unknown Individual – Cardiovascular Disease Physician, NPI 1699791137

Unknown Individual is a healthcare provider. based in Victoria, Texas. specializing in Cardiovascular Disease Physician. They hold a License No. J1254 (TX). The NPI Number for Unknown Individual is 1699791137

Main info

Organization
Inactive
56 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1699791137
Phone
(361) 572-0333
Address
1908 N LAURENT ST
Deactivation Date
31 August 2022

Doctor Profile

Medical School Name
UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Secondary Phone
3615739181
Graduation Year
1970 (56 years ago)
PAC ID
4688616782
Group Practice PAC ID
3577785096
Professional Enrollment ID
I20050531000336
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

  • 1908, North Laurent Street, Victoria, Victoria County, Texas, 77901, United States

    SUITE 550

    VICTORIA, TX 779015468

    Phone: (361) 572-0333

    Fax: (361) 572-0104

    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.

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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 77901)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINETX93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report20121348

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: 3577785096View full group profile
NameSpecialtyState
Radiation OncologyTX
U R O L O G YTX
Physician AssistantTX
-TX
Physician AssistantTX
Nurse PractitionerTX
-TX
Internal MedicineTX
Internal MedicineTX
Nurse PractitionerTX

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1699791137 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Victoria?
Unknown Individual currently maps to Victoria, Texas in this extract.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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