Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1164487351

Unknown Individual is a healthcare provider. based in Southwick, Massachusetts. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 003788 (CT). The NPI Number for Unknown Individual is 1164487351

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164487351
Phone
(413) 569-0964
Address
1 HUMMINGBIRD HOLW
Deactivation Date
26 June 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5612230174
Graduation Year
1984 (42 years ago)
PAC ID
1456362078
Group Practice PAC ID
2567600588
Professional Enrollment ID
I20070823000356
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

Provider Addresses for Unknown Individual

  • 1 HUMMINGBIRD HOLW

    SOUTHWICK, MA 010779530

    Phone: (413) 569-0964

    Type: Location

  • 40, Beach Road, Knollwood, Old Saybrook, Lower Connecticut River Valley Planning Region, Connecticut, 06475, United States

    OLD SAYBROOK, CT 064752802

    Phone: (413) 569-0964

    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 01077)

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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: 2567600588View full group profile
NameSpecialtyState
-FL
Certified Registered Nurse Anesthetist (Crna)FL
A N E S T H E S I O L O G YNY
A N E S T H E S I O L O G YMI
A N E S T H E S I O L O G YFL
-NY
Certified Registered Nurse Anesthetist (Crna)FL
Certified Registered Nurse Anesthetist (Crna)FL
-OH
Certified Registered Nurse Anesthetist (Crna)TN

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1164487351 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 does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Southwick, Massachusetts for Unknown Individual; expand the address list for detail.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1164487351. Always confirm identity and privileges with the practice and licensing boards.

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