Samantha Mae Aufderhaar, DNP, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Peoria, IL
NPI 1104603695 · NPPES record last updated Sep 11, 2023
Key facts
- NPI
- 1104603695
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 145026 (WI)
- Practice address
- 530 NE Glen Oak Ave
Peoria, IL 61637-0001 - Phone
- (309) 655-2000
- NPI assigned
- Sep 11, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Associated Anesthesiologists SC
Practice addresses (Care Compare)
6742 N Frostwood Pkwy
Peoria, IL 61615-2402
Phone (309) 692-5393
Hospital & facility affiliations
- Saint Francis Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231109000543 | IL | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 5597112763 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 145026 | WI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associated Anesthesiologists, SC | Current |
Accepting new patients | |
| Associated Anesthesiologists, S.C. | Current |
Accepting new patients |
Locations
6742 N Frostwood Pkwy
Peoria, IL 61615
Phone (309) 692-5393
530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393
530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 145026 | WI | Yes |
Addresses
Primary practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
901 Woodland Knolls Rd
Germantown Hills, IL 61548-9432
Phone (608) 886-8719
Other providers in Peoria, IL
- Michaeleen Atkisson
- Kaylee Atria
- Bethany Atterberry
- Joshua Michael Auer
- Lauren Hope Auer
- John E Augspurger
- Cynthia Angela Augustin
- Bhagat Aulakh
- Aunt Martha'S Health and Wellness, Inc.
- Aunt Martha'S Health and Wellness, Inc.
All providers in Peoria, IL · Certified Registered Nurse Anesthetist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.