Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1104822089

Unknown Individual is a healthcare provider. based in Dayton, Ohio. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 0024166000 (VA). The NPI Number for Unknown Individual is 1104822089

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104822089
Phone
(804) 349-3045
Address
4100 W 3RD ST
Deactivation Date
1 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9372086173
Graduation Year
1979 (47 years ago)
PAC ID
3476528506
Group Practice PAC ID
8820902794
Professional Enrollment ID
I20080304000101
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

  • West 3rd Street, Ridgewood Heights, Dayton, Montgomery County, Ohio, 45417:45427, United States

    DAYTON, OH 454289000

    Phone: (804) 349-3045

    Fax: (937) 987-0109

    Type: Location

  • 4100 WEST THIRD STREET

    VA MEDICAL CENTER

    DAYTON, OH 45428

    Phone: (804) 349-3045

    Fax: (937) 987-0109

    Type: Mailing

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 45428)

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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: 8820902794View full group profile
NameSpecialtyState
A N E S T H E S I O L O G YOH
Certified Registered Nurse Anesthetist (Crna)OH
-OH
-OH
-GA
Certified Registered Nurse Anesthetist (Crna)OH
Certified Registered Nurse Anesthetist (Crna)OH
A N E S T H E S I O L O G YOH
A N E S T H E S I O L O G YOH
-OH

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1104822089 when you need to reference Unknown Individual in forms, claims, or directories.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Dayton, Ohio because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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