Unknown Individual – Cardiovascular Disease Physician, NPI 1962405209

Unknown Individual is a healthcare provider. based in Lubbock, Texas. specializing in Cardiovascular Disease Physician. They hold a License No. E9409 (TX). The NPI Number for Unknown Individual is 1962405209

Main info

Organization
Inactive
56 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1962405209
Phone
(806) 780-8003
Address
3710 21ST ST
Deactivation Date
20 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8067808003
Graduation Year
1970 (56 years ago)
PAC ID
9133024029
Group Practice PAC ID
6901889393
Professional Enrollment ID
I20100615000134
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

  • 21st Street, Slaton-Bean, Lubbock, Texas, 79411, United States

    LUBBOCK, TX 794101220

    Phone: (806) 780-8003

    Fax: (806) 780-5423

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $22.

Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.

Last reported payment date: 2023-05-09 • Largest payer in this snapshot: ABBVIE INC. ($22).

Total Amount

$22

General + Research + Ownership

Payments

1

Total payment records

General Amount

$22

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-05-09

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$22
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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 79410)

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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 studies2424
CARDIOVASCULAR DISEASE (CARDIOLOGY)TX93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report2016
CARDIOVASCULAR DISEASE (CARDIOLOGY)TX93926Ultrasound study of arteries and arterial grafts of one leg or limited3129

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: 6901889393View full group profile

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1962405209 — the number used across U.S. healthcare to identify this provider.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Lubbock, Texas as the reference point for Unknown Individual, then confirm.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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