Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1053379891

Unknown Individual is a healthcare provider. based in Augusta, Georgia. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 554915 (TX). The NPI Number for Unknown Individual is 1053379891

Main info

Organization
Inactive
31 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053379891
Phone
(800) 394-4445
Address
804 SCOTT NIXON MEMORIAL DR
Deactivation Date
24 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3615780234
Graduation Year
1995 (31 years ago)
PAC ID
1254340490
Group Practice PAC ID
8921025016
Professional Enrollment ID
I20060417000108
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

  • Scott Nixon Memorial Drive, Foxhall, Augusta, Richmond County, Georgia, 30907, United States

    AUGUSTA, GA 309072464

    Phone: (800) 394-4445

    Type: Mailing

  • CHRISTUS Spohn Hospital Corpus Christi - Memorial, 2606, Hospital Boulevard, Corpus Christi, Nueces County, Texas, 78405, United States

    CORPUS CHRISTI, TX 784051818

    Phone: (757) 482-6732

    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.

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 30907)

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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: 8921025016View full group profile
NameSpecialtyState
O P H T H A L M O L O G YTX
O P T O M E T R YTX
O P T O M E T R YTX
O P T O M E T R YTX
O P T O M E T R YTX
O P T O M E T R YTX
O P H T H A L M O L O G YCA
O P H T H A L M O L O G YTN
O P T O M E T R YTX
-TX

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1053379891.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Augusta, Georgia in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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