Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1508230939

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Tinley park, Illinois. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 209013629 (IL). The NPI Number for Unknown Individual is 1508230939

Main info

Organization

Inactive

11 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1508230939

Phone

(708) 372-5111

Address

8318 MICHELLE LN

Deactivation Date

14 June 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7084252552

Graduation Year

2015 (11 years ago)

PAC ID

5193028793

Group Practice PAC ID

1557587029

Professional Enrollment ID

I20160114001099

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

8318 MICHELLE LN
TINLEY PARK, IL 604771296
Phone: (708) 372-5111
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 60477)

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Provider's Procedures

Unknown Individual performs procedures in Certified Registered Nurse Anesthetist. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
CERTIFIED REGISTERED NURSE ANESTHET	IL	01402	Anesthesia for open or endoscopic total knee joint replacement	11	11

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: 1557587029View full group profile

Name	Specialty	State
JEFFREY J. RYAN (CRNA)	-	IL
MS. DENA VINCENT (CRNA)	Certified Registered Nurse Anesthetist (Crna)	IL

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?

For Unknown Individual, use NPI 1508230939 as the unique 10-digit identifier.

Does inactive status mean Unknown Individual stopped practicing?

Inactive registry status can reflect deactivation, consolidation, or data lag.

How would a patient describe Unknown Individual's focus?

For Unknown Individual, the primary taxonomy reads as Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.

What practice footprint exists for Unknown Individual?

Travel planning: use Tinley Park, Illinois as the reference point for Unknown Individual, then confirm.

Does Unknown Individual accept insurance?

Insurance participation is not part of the core NPI extract — call the plan or office to confirm.