Unknown Individual – Primary Care Clinic/Center, NPI 1720095250

Unknown Individual is a healthcare provider. based in Dallas, Texas. specializing in Primary Care Clinic/Center. They hold a License No. K5165 (TX). The NPI Number for Unknown Individual is 1720095250

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1720095250
Phone
(214) 956-0854
Address
3630 ALMAZAN DR
Deactivation Date
25 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1986 (40 years ago)
PAC ID
5991969628
Professional Enrollment ID
I20120611000087
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

  • 3630, Almazan Drive, Midway Hollow, Dallas, Dallas County, Texas, 75220, United States

    DALLAS, TX 752204929

    Phone: (214) 956-0854

    Fax: (214) 956-7290

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes4226$0
View full utilization report →

Insurance plans in this area (ZIP 75220)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1720095250 for Unknown Individual, then check state licensing separately.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Primary Care Clinic/Center. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Dallas, Texas in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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