Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1124373535

Unknown Individual is a healthcare provider. based in Newark, Ohio. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 13839NA (OH). The NPI Number for Unknown Individual is 1124373535

Main info

Organization
Inactive
14 Years Of Experience
Name
Unknown Individual
NPI
1124373535
Phone
(220) 564-4226
Address
1320 WEST MAIN STREET
Deactivation Date
21 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7406226411
Graduation Year
2012 (14 years ago)
PAC ID
6608025416
Group Practice PAC ID
2264866169
Professional Enrollment ID
I20121010000329
Data current as of
20 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

  • 1320 WEST MAIN STREET

    NEWARK, OH 43055

    Phone: (220) 564-4226

    Fax: (220) 564-4217

    Mailing address matches the actual address.

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 43055)

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Provider's Procedures

Unknown Individual performs procedures in Certified Registered Nurse Anesthetist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CERTIFIED REGISTERED NURSE ANESTHETOH00142Anesthesia for lens surgery5353

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: 2264866169View full group profile
NameSpecialtyState
-OH
-OH
Nurse PractitionerOH
Certified Registered Nurse Anesthetist (Crna)OH
Certified Registered Nurse Anesthetist (Crna)OH
Certified Registered Nurse Anesthetist (Crna)OH

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1124373535 if you need a stable reference for Unknown Individual.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Certified Registered Nurse Anesthetist for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Newark, Ohio for Unknown Individual based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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