Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1073068011

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Urbana, Illinois. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 41.373925 (IL). The NPI Number for Unknown Individual is 1073068011

Main info

Organization

Inactive

11 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1073068011

Phone

Not provided

Address

1400 W PARK ST

Deactivation Date

9 August 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2173372000

Graduation Year

2015 (11 years ago)

PAC ID

9436445624

Group Practice PAC ID

3971498924

Professional Enrollment ID

I20160914003000

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness75

Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

OSF Heart of Mary Medical Center, 1400, West Park Street, Urbana, Champaign County, Illinois, 61801, United States
URBANA, IL 618012334
Phone:
Mailing address matches the actual address.

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 61801)

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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: 3971498924View full group profile

Name	Specialty	State
MARINA SALDARIS (C.R.N.A)	Certified Registered Nurse Anesthetist (Crna)	IN
DR. SHILPA THAKKAR (MD)	A N E S T H E S I O L O G Y	IL
MICHELA M KWAK	Certified Registered Nurse Anesthetist (Crna)	IL
VENUGOPAL POLASANI (MD)	-	GA
KENNETH C LEEBERG (CRNA)	Certified Registered Nurse Anesthetist (Crna)	IL
DR. KAVERI WARRIAR (M.D)	-	MI
DR. STEVEN JIOTIS (MD)	A N E S T H E S I O L O G Y	IL
JONATHAN MANGAN	Certified Registered Nurse Anesthetist (Crna)	IL
CARA A MURPHY (CRNA)	Certified Registered Nurse Anesthetist (Crna)	IL
DR. SOHAN KUMAR KHATIWADA (M.D)	-	MI

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1073068011.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

Which specialty label fits Unknown Individual?

NPPES ties Unknown Individual to Certified Registered Nurse Anesthetist in the taxonomy section. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Urbana, Illinois in registry-derived data.

What is the difference between NPI and a medical license?

An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.