Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1003857293

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Travis afb, California. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 459018-1 (NY). The NPI Number for Unknown Individual is 1003857293

Main info

Organization

Inactive

32 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1003857293

Phone

(707) 423-3589

Address

101 BODIN CIR

Deactivation Date

1 January 2026

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6314746000

Graduation Year

1994 (32 years ago)

PAC ID

3476619727

Group Practice PAC ID

7113825381

Professional Enrollment ID

I20100715000954

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

101, Bodin Circle, Fairfield, Solano County, California, 94535, United States
TRAVIS AFB, CA 945351809
Phone: (707) 423-3589
Type: Location
Villaggio Circle, Villagio, Vacaville, Solano County, California, 95688, United States
VACAVILLE, CA 956888774
Phone: (707) 372-4589
Type: Mailing

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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
00902	Anesthesia for procedure on anus and rectum	15	15	$0

View full utilization report →

Insurance plans in this area (ZIP 94535)

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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: 7113825381View full group profile

Name	Specialty	State
MICHAEL A NEMIROV (MD)	A N E S T H E S I O L O G Y	NY
Unknown Individual	-	NY
DR. SASSAN MOHTADI (MD)	A N E S T H E S I O L O G Y	NY
DR. RICHARD PETERS (M.D.)	-	NY
DR. DANIEL FELDMAN (MD)	A N E S T H E S I O L O G Y	NY
DR. MICHAEL WAINFELD (MD)	A N E S T H E S I O L O G Y	NY
LEAH KAY (CRNA)	-	NY
ROSEMARY LANE (C.R.N.A)	-	NY
DR. LAURENCE DION HARING (M.D.)	A N E S T H E S I O L O G Y	NY
LEONARD A GOLDBERG (CRNA)	Certified Registered Nurse Anesthetist (Crna)	NY

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1003857293 for Unknown Individual, then check state licensing separately.

Is Unknown Individual's NPI deactivated?

The extract indicates Unknown Individual is not in an active NPI state.

What healthcare role does Unknown Individual hold?

Scheduling teams often label Unknown Individual under Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.

What area does Unknown Individual serve?

Unknown Individual's listing highlights Travis Afb, California; more addresses can appear in NPPES.

What does 'Individual Provider' mean on this profile?

Entity type tells you whether the number belongs to a person or an organization.