Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1114903473

Unknown Individual is a healthcare provider. based in Bridgeport, Connecticut. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 002199 (CT). The NPI Number for Unknown Individual is 1114903473

Main info

Organization
Inactive
27 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114903473
Phone
(203) 929-7353
Address
2800 MAIN ST
Deactivation Date
30 August 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2036884242
Graduation Year
1999 (27 years ago)
PAC ID
5294799847
Group Practice PAC ID
9436061736
Professional Enrollment ID
I20041115000441
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

  • Daniel T Banks Health Science Library, 2800, Main Street, Bridgeport, Fairfield County, Connecticut, 06606, United States

    ST VINCENTS MEDICAL CENTER

    BRIDGEPORT, CT 066064201

    Phone: (203) 929-7353

    Fax: (203) 929-0756

    Type: Location

  • 4, Armstrong Road, Fairchild Heights Trailer Park, Shelton, Fairfield County, Connecticut, 06484, United States

    SHELTON, CT 064844721

    Phone: (203) 929-7353

    Fax: (203) 929-0756

    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.

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

Insurance plans in this area (ZIP 06606)

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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: 9436061736View full group profile
NameSpecialtyState
Interventional Cardiology, Cardiovascular Disease (Cardiology)CT
H E M A T O L O G Y/ O N C O L O G YCT
Internal Medicine, NephrologySC
-CT
-NC
Internal MedicineCT
-CT
Cardiac SurgeryCT
-CT
-CT

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1114903473; it appears in the national provider directory.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Bridgeport, Connecticut for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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