Unknown Individual – Family Medicine Physician, NPI 1790788750
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2014-04-20. Reason: Conviction of program-related crimes (mandatory; min. 5 years).
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Raintree Circle, Sulphur Springs, Hopkins County, Texas, 75482, United States
SULPHUR SPRINGS, TX 754822134
Phone: (903) 439-4408
Fax: (903) 885-7126
Type: Mailing
Medical Drive, Sulphur Springs, Hopkins County, Texas, 75482, United States
SUITE B
SULPHUR SPRINGS, TX 754822199
Phone: (903) 439-4408
Fax: (903) 885-7126
Type: Location
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.
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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 75482)
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