Unknown Individual – Anesthesiology Physician, NPI 1386648814

Unknown Individual is a healthcare provider. based in Auburn, Washington. specializing in Anesthesiology Physician. They hold a License No. OP00000905 (WA). The NPI Number for Unknown Individual is 1386648814

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1386648814
Phone
(253) 288-2140
Address
101 2ND ST NE
Deactivation Date
19 March 2026

Doctor Profile

Medical School Name
AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Secondary Phone
2534031000
Graduation Year
1980 (46 years ago)
PAC ID
4183515042
Group Practice PAC ID
4284523499
Professional Enrollment ID
I20110103000817
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

  • South Sound Surgery - John Conrad, MD, 101, 2nd Street Northeast, Downtown, Auburn, King County, Washington, 98071, United States

    STE B

    AUBURN, WA 980024906

    Phone: (253) 288-2140

    Type: Location

  • PO BOX 97115

    LAKEWOOD, WA 984970115

    Phone: (253) 588-7911

    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.

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110103000817IAnesthesiologyWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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 98002)

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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: 4284523499View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)WA
-TX
Certified Registered Nurse Anesthetist (Crna)WA
Certified Registered Nurse Anesthetist (Crna)IL
Certified Registered Nurse Anesthetist (Crna)OR
Certified Registered Nurse Anesthetist (Crna)OR
A N E S T H E S I O L O G YWA
Certified Registered Nurse Anesthetist (Crna)NE
A N E S T H E S I O L O G YGA
-WA

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1386648814?
NPI 1386648814 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Anesthesiology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Auburn?
Unknown Individual currently maps to Auburn, Washington in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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