Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1093292005

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Royal oak, Michigan. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 4704295574 (MI). The NPI Number for Unknown Individual is 1093292005

Main info

Organization

Inactive

8 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1093292005

Phone

(248) 898-5000

Address

3601 W 13 MILE RD

Deactivation Date

21 June 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8102629353

Graduation Year

2018 (8 years ago)

PAC ID

7315299476

Group Practice PAC ID

2961308481

Professional Enrollment ID

I20181017003647

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

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Provider Addresses for Unknown Individual

Beaumont Hospital - Royal Oak, 3601, West 13 Mile Road, Royal Oak, Oakland County, Michigan, 48073, United States
ROYAL OAK, MI 480736712
Phone: (248) 898-5000
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 48073)

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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: 2961308481View full group profile

Name	Specialty	State
DR. RYAN J. REECE (M.D.)	Emergency Medicine	MI
ALEESHA KILBREATH (PA-C)	Physician Assistant	MI
FRANCIS C WELLS (PA-C)	Physician Assistant	MI
GAYLE LOURENS (CRNA)	Certified Registered Nurse Anesthetist (Crna)	MI
MELISSA MARIE MILLER (PA-C)	Physician Assistant	MI
ALISON SPALDING	Certified Registered Nurse Anesthetist (Crna)	MI
DEVON KWAPIS	Physician Assistant	MI
ALEXSIS M PARKS (PA)	Physician Assistant	OH
TYLER WUNDRACH (PA-C)	Physician Assistant	MI
NIKHIL K VORA (MD)	P S Y C H I A T R Y	MI

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1093292005.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What services align with Unknown Individual's listing?

Unknown Individual's public classification highlights Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Royal Oak, Michigan in registry-derived data.

Who maintains Unknown Individual's record?

Providers certify NPPES data; CMS hosts the public file you are viewing.