Unknown Individual – Anesthesiology Physician, NPI 1871540856

Unknown Individual is a healthcare provider. based in Waconia, Minnesota. specializing in Anesthesiology Physician. They hold a License No. 47563 (MN). The NPI Number for Unknown Individual is 1871540856

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1871540856
Phone
(952) 442-9770
Address
400 E 10TH ST
Deactivation Date
16 August 2023

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
7632712303
Graduation Year
2001 (25 years ago)
PAC ID
3678509692
Group Practice PAC ID
0042444580
Professional Enrollment ID
I20050712000222
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 400, East 10th Street, Interlaken West, Waconia, Carver County, Minnesota, 55387, United States

    WACONIA, MN 553874552

    Phone: (952) 442-9770

    Fax: (952) 442-3630

    Type: Mailing

  • CentraCare Health – Monticello, 1013, Hart Boulevard, Monticello, Wright County, Minnesota, 55362, United States of America

    MONTICELLO, MN 553628575

    Phone: (763) 295-2945

    Fax: (763) 271-2421

    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 55387)

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Provider's Procedures

Unknown Individual performs procedures in Anesthesiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ANESTHESIOLOGYMN00142Anesthesia for lens surgery1111

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: 0042444580View full group profile
NameSpecialtyState
DR. CHRIS A RODAHL
-MN
MRS. MARCIA ANN KLUCK (CRNA)
-MN
MICHAEL BOND (CRNA)
-MN

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1871540856 uniquely identifies Unknown Individual in U.S. healthcare data.
What should I verify if Unknown Individual is listed inactive?
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 Anesthesiology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Waconia, Minnesota?
If you are local to Waconia, Minnesota, Unknown Individual may be relevant to your search.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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