Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1700887122

Unknown Individual is a healthcare provider. based in Rolla, Missouri. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 093954 (MO). The NPI Number for Unknown Individual is 1700887122

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1700887122
Phone
(573) 458-3391
Address
PO BOX 1216
Deactivation Date
24 April 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5734588899
Graduation Year
2000 (26 years ago)
PAC ID
8426044082
Group Practice PAC ID
2860391158
Professional Enrollment ID
I20110330000717

Contacts

FHIR Endpoint
https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • ROLLA, Lane 3 West, Baridhara, Dhaka, Chanpara Bazar, Dhaka District, Dhaka Division, 1230, Bangladesh

    ROLLA, MO 654021579

    Phone: (573) 458-3391

    Type: Mailing

  • 751 Sappington Bridge Rd

    Sullivan, MO 630802354

    Phone: (573) 468-1343

    Type: Location

  • 1050, West 10th Street, Rolla, Phelps County, Missouri, 65401, United States

    ROLLA, MO 654012905

    Phone: (573) 458-3391

    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 $145.

Total Amount is formed as General ($145) + Research ($0) + Ownership ($0) = $145.

Last reported payment date: 2024-02-06 • Largest payer in this snapshot: Nevro Corp. ($56).

Total Amount

$145

General + Research + Ownership

Payments

8

Total payment records

General Amount

$145

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-02-06

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 65402)

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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: 2860391158View full group profile
NameSpecialtyState
A N E S T H E S I O L O G YMO
Internal MedicineMO
Nurse PractitionerMO
Certified Registered Nurse Anesthetist (Crna)MO
-MO
Interventional Cardiology, Cardiovascular Disease (Cardiology)MO
-MO
Internal MedicineIL
Hospitalist, Internal MedicineAR
Critical Care (Intensivists)MO

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1700887122.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Rolla, Missouri as a primary anchor for Unknown Individual unless the record lists multiple sites.
Why does Unknown Individual have multiple addresses?
3 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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