Unknown Individual – Medical Physician Assistant, NPI 1396764155

Unknown Individual is a healthcare provider. based in San antonio, Texas. specializing in Medical Physician Assistant. They hold a License No. 02572 (TX). The NPI Number for Unknown Individual is 1396764155

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1396764155
Phone
(830) 328-4206
Address
PO BOX 591819
Deactivation Date
6 February 2025
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

  • PO box, Russell Road, Paoli, Tredyffrin Township, Chester County, Pennsylvania, 19301, United States

    SAN ANTONIO, TX 782590140

    Phone: (830) 328-4206

    Fax: (210) 966-9106

    Type: Mailing

  • 109, Falls Court, Boerne, Kendall County, Texas, 78006, United States

    STE 100

    BOERNE, TX 78006

    Phone: (210) 495-5771

    Fax: (210) 495-0155

    Type: Location

  • 18322 Sonterra Pl Ste 107

    San Antonio, TX 782584196

    Phone: (210) 495-5771

    Fax: (210) 966-9105

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 202 Open Payments records for all available years, with a total value of $203,458.

Total Amount is formed as General ($203,458) + Research ($0) + Ownership ($0) = $203,458.

Last reported payment date: 2024-08-13 • Largest payer in this snapshot: ABBVIE INC. ($203,167).

Total Amount

$203,458

General + Research + Ownership

Payments

202

Total payment records

General Amount

$203,458

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-13

Latest reported date

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 78259)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1396764155.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Medical Physician Assistant in the taxonomy section. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to San Antonio, Texas in registry-derived data.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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