Unknown Individual – Cardiovascular Disease Physician, NPI 1710143458

Unknown Individual is a healthcare provider. based in Mansfield, Texas. specializing in Cardiovascular Disease Physician. They hold a License No. N8833 (TX). The NPI Number for Unknown Individual is 1710143458

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710143458
Phone
(214) 884-7525
Address
221 REGENCY PKWY
Deactivation Date
21 July 2022

Doctor Profile

Medical School Name
UNIVERSITY COLLEGE OF MEDICINE
Secondary Phone
2148847525
Graduation Year
2003 (23 years ago)
PAC ID
8426226440
Group Practice PAC ID
0042529653
Professional Enrollment ID
I20110719000285
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 221, Regency Parkway, Walnut Landing, Mansfield, Tarrant County, Texas, 76063, United States

    SUITE 105

    MANSFIELD, TX 760635379

    Phone: (214) 884-7525

    Fax: (214) 884-7551

    Type: Location

  • Cedar Hill, Box Elder County, Utah, United States

    CEDAR HILL, TX 751064532

    Phone: (214) 884-7525

    Fax: (214) 884-7551

    Type: Mailing

  • 2727 Bolton Boone Dr Ste 112

    DeSoto, TX 751152019

    Phone: (214) 884-7525

    Type: Location

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 $25.

Total Amount is formed as General ($25) + Research ($0) + Ownership ($0) = $25.

Last reported payment date: 2023-04-14 • Largest payer in this snapshot: Boston Scientific Corporation ($25).

Total Amount

$25

General + Research + Ownership

Payments

1

Total payment records

General Amount

$25

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-04-14

Latest reported date

Top Companies

Largest payers in this snapshot

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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 76063)

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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
CARDIOVASCULAR DISEASE (CARDIOLOGY)TX78452Nuclear medicine study of vessels of heart using drugs or exercise multiple studies5858
CARDIOVASCULAR DISEASE (CARDIOLOGY)TX93458Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart5855

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1710143458.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Cardiovascular Disease Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Mansfield, Texas in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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