Unknown Individual – Anesthesiology Physician, NPI 1609827815

Unknown Individual is a healthcare provider. based in Jackson, Michigan. specializing in Anesthesiology Physician. They hold a License No. 036074936 (IL). The NPI Number for Unknown Individual is 1609827815

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1609827815
Phone
(800) 242-1131
Address
255 W MICHIGAN AVE
Deactivation Date
4 December 2025

Doctor Profile

Medical School Name
STATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Secondary Phone
8153185666
Graduation Year
1985 (41 years ago)
PAC ID
7618935677
Group Practice PAC ID
6103884150
Professional Enrollment ID
I20041222000699
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: (800) 242-1131

    Fax: (517) 787-4146

    Type: Mailing

  • Morris Hospital, 150, West High Street, Morris, Grundy County, Illinois, 60450, United States

    MORRIS, IL 604501463

    Phone: (630) 472-8800

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 8 Open Payments records for all available years, with a total value of $358.

Total Amount is formed as General ($358) + Research ($0) + Ownership ($0) = $358.

Last reported payment date: 2024-05-28 • Largest payer in this snapshot: Boston Scientific Corporation ($157).

Total Amount

$358

General + Research + Ownership

Payments

8

Total payment records

General Amount

$358

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-28

Latest reported date

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
00813Anesthesia for procedure on small and large bowel using an endoscope8282$0
00731Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope6664$0
00142Anesthesia for lens surgery5955$0
00811Anesthesia for other procedure on large bowel using an endoscope5353$0
01480Anesthesia for other procedure on lower leg, ankle, and foot bones2424$0
View full utilization report →

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: 6103884150View full group profile

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1609827815; it appears in the national provider directory.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Anesthesiology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Jackson, Michigan because that is what the record indicates for Unknown Individual.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1609827815. Always confirm identity and privileges with the practice and licensing boards.

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