Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1164487252

Unknown Individual is a healthcare provider. based in Springfield, Massachusetts. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 39123 (MA). The NPI Number for Unknown Individual is 1164487252

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164487252
Phone
(413) 599-4994
Address
PO BOX 2608
Deactivation Date
29 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7322402277
Graduation Year
1977 (49 years ago)
PAC ID
2264590223
Group Practice PAC ID
5395980775
Professional Enrollment ID
I20120515000479
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

  • 2608, North Peoria Road, Ridgely, Springfield, Sangamon County, Illinois, 62702, United States

    SPRINGFIELD, MA 01101

    Phone: (413) 599-4994

    Fax: (413) 599-4969

    Type: Mailing

  • 2141, Boston Road, Wilbraham, Hampden County, Massachusetts, 01056-2785, United States

    WILBRAHAM, MA 01095

    Phone: (413) 599-4994

    Fax: (413) 599-4969

    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 01101)

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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: 5395980775View full group profile
NameSpecialtyState
Pain Management, AnesthesiologyNH
Nurse PractitionerNJ
Physical Medicine And RehabilitationKY
-NJ
A N E S T H E S I O L O G YNJ
Physical Medicine And RehabilitationNJ
Physical Medicine And RehabilitationNJ
-NJ
Interventional Pain Management, AnesthesiologyNJ
Nurse PractitionerNJ

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1164487252.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Springfield, Massachusetts.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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