Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1245537257

Unknown Individual is a healthcare provider. based in Newcastle, Oklahoma. specializing in Certified Registered Nurse Anesthetist. They hold a License No. 64922 (OK). The NPI Number for Unknown Individual is 1245537257

Main info

Organization
Inactive
15 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1245537257
Phone
(405) 816-6909
Address
3679 RIVERFRONT DR
Deactivation Date
15 January 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4057021300
Graduation Year
2011 (15 years ago)
PAC ID
0244483600
Group Practice PAC ID
7315939279
Professional Enrollment ID
I20130115000101
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

  • 3679 RIVERFRONT DR

    NEWCASTLE, OK 730656617

    Phone: (405) 816-6909

    Type: Mailing

  • 3705 NW 63RD ST STE 100

    OKLAHOMA CITY, OK 731161937

    Phone: (405) 463-3484

    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.

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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 73065)

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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: 7315939279View full group profile
NameSpecialtyState
-OK
Gastroenterology, Internal MedicineOK
-OK
Physician AssistantOK
Nurse PractitionerOK
Internal Medicine, GastroenterologyOK
Gastroenterology, Internal MedicineOK
Nurse PractitionerOK
Nurse PractitionerOK
-OK

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1245537257 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Newcastle, Oklahoma.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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