Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1821040122

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Centralia, Illinois. specializing in Certified Registered Nurse Anesthetist. They hold a License No. RN 041325048 (IL). The NPI Number for Unknown Individual is 1821040122

Main info

Organization

Inactive

44 Years Of Experience

Name

Unknown Individual

NPI

1821040122

Phone

(618) 532-3110

Address

1045 M L KING DR

Deactivation Date

7 February 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6186622131

Graduation Year

1982 (44 years ago)

PAC ID

0345136875

Group Practice PAC ID

0042101982

Professional Enrollment ID

I20061009000011

Data current as of

19 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

1045, M L King Drive, Centralia, Marion County, Illinois, 62801, United States
CENTRALIA, IL 628013001
Phone: (618) 532-3110
Fax: (618) 532-7226
Type: Location
3650, East Bishop Road, Mount Vernon, Jefferson County, Illinois, 62864, United States
MOUNT VERNON, IL 628648292
Phone: (618) 242-3979
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 62801)

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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: 0042101982View full group profile

Name	Specialty	State
CATHERINE NICOLE DETERS	Nurse Practitioner	IL
MRS. JESSIE ROSANNE SMITH (LCSW)	Clinical Social Worker	IL
MRS. JACKLYN KAY STANLEY (APRN)	Nurse Practitioner	IL
SARAH JANE BRASHEAR (FNP-C)	Nurse Practitioner	IL
KARA DOBYNS (PMHNP)	Nurse Practitioner	IL
SCOUT SANDERS	Clinical Social Worker	IL
BINH T NGUYEN (D.O)	Cardiac Electrophysiology, Cardiovascular Disease (Cardiology)	MO
BRANDON CYCHOLL	Family Practice	IL
DR. ASHOK KUMAR (M.D.)	General Surgery	IL
HEATHER ZIMMERMAN (FNP-C)	Nurse Practitioner	IL

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?

The NPI 1821040122 uniquely identifies Unknown Individual in U.S. healthcare data.

Does inactive mean outdated data for Unknown Individual?

Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.

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.

Is Unknown Individual tied to Centralia, Illinois?

If you are local to Centralia, Illinois, Unknown Individual may be relevant to your search.

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.