Unknown Individual – Certified Registered Nurse Anesthetist, NPI 1457312068

Unknown Individual is a healthcare provider. based in Victoria, Texas. specializing in Certified Registered Nurse Anesthetist. They hold a License No. AP102589 (TX). The NPI Number for Unknown Individual is 1457312068

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1457312068
Phone
(361) 573-6291
Address
1501 E MOCKINGBIRD LN STE 101
Deactivation Date
21 January 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3615526713
Graduation Year
1976 (50 years ago)
PAC ID
6204815996
Group Practice PAC ID
5395636716
Professional Enrollment ID
I20040716000039
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 101, East Mockingbird Lane, Victoria, Victoria County, Texas, 77904, United States

    VICTORIA, TX 779042178

    Phone: (361) 573-6291

    Fax: (361) 576-2434

    Type: Mailing

  • Memorial Medical Center, 815, North Virginia Street, Port Lavaca, Calhoun County, Texas, 77979, United States

    MEMORIAL MEDICAL CENTER

    PORT LAVACA, TX 779793025

    Phone: (361) 552-6713

    Fax: (361) 552-0338

    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.

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 77904)

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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: 5395636716View full group profile
NameSpecialtyState
ROBERT D COLEMAN (CRNA)
-TX
RALPH SMITH (C.R.N.A.)
-TX
EVELYN J WILCOX (C.R.N.A.)
-TX
KYLE ANDREW SHNOWSKI (CRNA)
-TX
JOHN W MCNEELY (MD)
-TX

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1457312068; it appears in the national provider directory.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
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.
What location metadata exists for Unknown Individual?
The page summarizes Victoria, Texas for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.