Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1013957018

Unknown Individual is a healthcare provider. based in Jackson, Michigan. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 0001082671 (VA). The NPI Number for Unknown Individual is 1013957018

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013957018
Phone
(517) 787-6440
Address
255 W MICHIGAN AVE
Deactivation Date
19 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2005 (21 years ago)
PAC ID
2961404785
Group Practice PAC ID
6800790023
Professional Enrollment ID
I20110517000463
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

  • 255, West Michigan Avenue, Jackson, Jackson County, Michigan, 49201, United States

    JACKSON, MI 492012218

    Phone: (517) 787-6440

    Fax: (517) 787-4146

    Type: Mailing

  • Inova Schar Heart and Vascular, 3300, Gallows Road, Falls Church, Fairfax County, Virginia, 22042, United States

    FALLS CHURCH, VA 220423307

    Phone: (703) 698-3138

    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 49201)

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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: 6800790023View full group profile
NameSpecialtyState
A N E S T H E S I O L O G YVA
A N E S T H E S I O L O G YPA
Certified Registered Nurse Anesthetist (Crna)TX
Certified Registered Nurse Anesthetist (Crna)VA
-VA
Certified Registered Nurse Anesthetist (Crna)TX
Certified Registered Nurse Anesthetist (Crna)VA
-NC
-NC
-VA

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1013957018 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Certified Registered Nurse Anesthetist in the directory — Clinical services aligned with this taxonomy classification.
Where in Michigan is Unknown Individual registered?
Use Jackson, Michigan as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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