Unknown Individual – General Practice Physician, NPI 1861421257
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2014-03-20. Reason: Conviction of program-related crimes (mandatory; min. 5 years).
General Practice Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Loading map...
Provider Addresses for Unknown Individual
5105, Fairglen Drive, Plano, Collin County, Texas, 75093, United States
PLANO, TX 750934926
Phone: (214) 354-3184
Fax: (972) 381-1995
Type: Mailing
2929, Martin Luther King Junior Boulevard, South Dallas-Fair Park PID, Dallas, Dallas County, Texas, 75215, United States
DALLAS, TX 752152313
Phone: (214) 421-1420
Fax: (214) 421-1989
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75093)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.