Individual provider Active NPI

Samantha Lina Valle

  • Certified Registered Nurse Anesthetist
  • Holbrook, NY
National Provider Identifier
1033951959
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
697660 Issued in NY
Practice address
161 Avenue D
Holbrook, NY 11741-2333
Phone
(631) 672-3218
NPI assigned
Jun 11, 2024
Last updated
Oct 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 697660 NY Primary

Addresses

Primary practice location

161 Avenue D
Holbrook, NY 11741-2333

Mailing address

161 Avenue D
Holbrook, NY 11741-2333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241010001774 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577095926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
State University of New York at Stony Brook, School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fpa Hospital BasedGroup PAC ID 4789826694, 423 clinicians

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 241-6426

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
697660NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based Current Accepting new patients
Fpa Hospital Based Nurse Anesthetist, Certified Registered CurrentSince Sep 30, 2024 Accepting new patients
Fpa Hospital Based CurrentSince Sep 30, 2024 Accepting new patients

Locations

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1033951959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 AVENUE D",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117412333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 AVENUE D",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117412333",
            "telephone_number": "631-672-3218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLE",
        "first_name": "SAMANTHA",
        "middle_name": "LINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "697660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holbrook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.