Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1104390301

Unknown Individual is a healthcare provider. based in Chicago, Illinois. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 6589671 (NY). The NPI Number for Unknown Individual is 1104390301

Main info

Organization
Inactive
8 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104390301
Phone
(646) 250-2131
Address
2756 N PINE GROVE AVE APT 403
Deactivation Date
10 February 2022

Doctor Profile

Medical School Name
RUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
Secondary Phone
7087561000
Graduation Year
2018 (8 years ago)
PAC ID
0547500480
Group Practice PAC ID
4688893878
Professional Enrollment ID
I20190313000123
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 2756 N PINE GROVE AVE APT 403

    CHICAGO, IL 606146165

    Phone: (646) 250-2131

    Type: Mailing

  • Presence Saint Mary Campus, 2233, West Division Street, Wicker Park, West Town, Chicago, Cook County, Illinois, 60622, United States

    CHICAGO, IL 606228151

    Phone: (312) 770-2000

    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 60614)

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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: 4688893878View full group profile
NameSpecialtyState
-IL
Certified Registered Nurse Anesthetist (Crna)WA
Certified Registered Nurse Anesthetist (Crna)IL
A N E S T H E S I O L O G YIL
Anesthesiology, Interventional Pain Management, Pain ManagementIL
Anesthesiology, Interventional Pain ManagementIL
A N E S T H E S I O L O G YNY
Certified Registered Nurse Anesthetist (Crna)IL
Anesthesiology, Interventional Pain ManagementIL
A N E S T H E S I O L O G YIL

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1104390301 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Certified Registered Nurse Anesthetist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Illinois?
You will see Chicago, Illinois on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1104390301. Always confirm identity and privileges with the practice and licensing boards.

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