Unknown Individual – Family Nurse Practitioner, NPI 1720397771

Unknown Individual is a healthcare provider. based in Broaddus, Texas. specializing in Family Nurse Practitioner. They hold a License No. 634541 (TX). The NPI Number for Unknown Individual is 1720397771

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1720397771
Phone
(936) 872-1077
Address
PO BOX 305
Deactivation Date
5 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4093843430
Graduation Year
2010 (16 years ago)
PAC ID
8022280908
Group Practice PAC ID
7113958539
Professional Enrollment ID
I20111019000408
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • PO BOX 305

    BROADDUS, TX 759290305

    Phone: (936) 872-1077

    Fax: (936) 872-1003

    Type: Mailing

  • 1103 FM 2558

    BROADDUS, TX 75929

    Phone: (936) 872-1077

    Fax: (936) 872-1003

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 6 Open Payments records for all available years, with a total value of $115.

Total Amount is formed as General ($115) + Research ($0) + Ownership ($0) = $115.

Last reported payment date: 2024-08-15 • Largest payer in this snapshot: Novo Nordisk Inc ($40).

Total Amount

$115

General + Research + Ownership

Payments

6

Total payment records

General Amount

$115

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-15

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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
99490Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month11324$0
View full utilization report →

Insurance plans in this area (ZIP 75929)

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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: 7113958539View full group profile
NameSpecialtyState
Nurse PractitionerTX
-TX
Nurse PractitionerTX
Nurse PractitionerTX
Family PracticeTX
-TX
Nurse PractitionerTX
Family PracticeTX
Nurse PractitionerLA

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1720397771.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Broaddus, Texas; more addresses can appear in NPPES.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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