Unknown Individual – Anesthesiology Physician, NPI 1790940641

Unknown Individual is a healthcare provider. based in South burlington, Vermont. specializing in Anesthesiology Physician. They hold a License No. 042.0012478 (VT). The NPI Number for Unknown Individual is 1790940641

Main info

Organization
Inactive
18 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790940641
Phone
(206) 375-0024
Address
31 WINDING BROOK DR
Deactivation Date
28 January 2022

Doctor Profile

Medical School Name
UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Secondary Phone
3073387752
Graduation Year
2008 (18 years ago)
PAC ID
4486807567
Group Practice PAC ID
2961403639
Professional Enrollment ID
I20130830000687
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

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Provider Addresses for Unknown Individual

  • 31, Winding Brook Drive, New Albany, Cinnaminson, Cinnaminson Township, Burlington County, New Jersey, 08077, United States

    SOUTH BURLINGTON, VT 054036736

    Phone: (206) 375-0024

    Type: Mailing

  • 2301 House Ave Ste 201

    Cheyenne, WY 820013177

    Phone: (307) 638-7757

    Fax: (307) 638-8359

    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 05403)

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Provider's Procedures

Unknown Individual performs procedures in Anesthesiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ANESTHESIOLOGYVT76942Ultrasonic guidance imaging supervision and interpretation for insertion of needle3332

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: 2961403639View full group profile
NameSpecialtyState
Internal Medicine, Cardiovascular Disease (Cardiology)MA
N E P H R O L O G YKY
Interventional Cardiology, Internal Medicine, Cardiovascular Disease (Cardiology)IL
-WY
Internal Medicine, Internal Medicine, HospitalistCO
Physician AssistantWY
N E U R O L O G YWY
Family PracticeWY
Physical Therapist In Private PracticeWY
Physical Therapist In Private PracticeWY

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1790940641.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
How should patients interpret Unknown Individual's specialty?
The extract shows Anesthesiology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to South Burlington, Vermont in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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