Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1275656134

Unknown Individual is a healthcare provider. based in Warren, Michigan. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 4704239465 (MI). The NPI Number for Unknown Individual is 1275656134

Main info

Organization
Inactive
20 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1275656134
Phone
(586) 246-8956
Address
15179 RAPHAEL TER
Deactivation Date
25 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2488493000
Graduation Year
2006 (20 years ago)
PAC ID
6709986615
Group Practice PAC ID
8325342488
Professional Enrollment ID
I20070706000374
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

Provider Addresses for Unknown Individual

  • 15179 RAPHAEL TER

    WARREN, MI 480883905

    Phone: (586) 246-8956

    Type: Mailing

  • 22101 MOROSS RD

    DETROIT, MI 482362148

    Phone: (313) 343-4766

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $23.

Total Amount is formed as General ($23) + Research ($0) + Ownership ($0) = $23.

Last reported payment date: 2024-05-03 • Largest payer in this snapshot: Boston Scientific Corporation ($23).

Total Amount

$23

General + Research + Ownership

Payments

1

Total payment records

General Amount

$23

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-03

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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 48088)

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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: 8325342488View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)MI
-MI
-MI
-MI
Certified Registered Nurse Anesthetist (Crna)MI
-MI
-MI
-FL

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1275656134 — is the standard way to identify this listing.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Certified Registered Nurse Anesthetist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Warren, Michigan; more addresses can appear in NPPES.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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