Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1104800937

Certified Registered Nurse Anesthetist

Unknown Individual is a healthcare provider. based in Cleveland, Tennessee. specializing in Certified Registered Nurse Anesthetist. They hold a License No. RN79266 (TN). The NPI Number for Unknown Individual is 1104800937

Main info

Organization

Inactive

30 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1104800937

Phone

(423) 472-6513

Address

2080 CHAMBLISS AVE

Deactivation Date

29 January 2026

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7068765000

Graduation Year

1996 (30 years ago)

PAC ID

4284693318

Group Practice PAC ID

5890692305

Professional Enrollment ID

I20080421000157

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

2080, Chambliss Avenue Northwest, North Cleveland, Cleveland, Bradley County, East Tennessee, Tennessee, 37311, United States
CLEVELAND ANESTHESIOLOGISTS INC
CLEVELAND, TN 37311
Phone: (423) 472-6513
Fax: (423) 476-2062
Type: Location
Box, Cleveland County, Oklahoma, United States
CLEVELAND, TN 373203090
Phone: (423) 472-6513
Fax: (423) 476-2062
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 37311)

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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: 5890692305View full group profile

Name	Specialty	State
BERNARD III HEIN (MD)	-	GA
DR. KATHLEEN MAHVI (M.D.)	-	GA
CHERI PROCTOR BENTON (CRNA)	Certified Registered Nurse Anesthetist (Crna)	TN

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?

Use NPI 1104800937 when you need to reference Unknown Individual in forms, claims, or directories.

What is the next step if Unknown Individual is inactive?

Treat inactive as a signal to verify Unknown Individual through official channels.

Does Unknown Individual list a primary specialty?

If you are matching referrals, note Certified Registered Nurse Anesthetist for Unknown Individual. Clinical services aligned with this taxonomy classification.

Does Unknown Individual practice in Tennessee?

You will see Cleveland, Tennessee on file for Unknown Individual alongside any extra practice locations.

Is Unknown Individual a real provider?

This page reflects official NPPES data for NPI 1104800937. Always confirm identity and privileges with the practice and licensing boards.