Samantha Larue Greenwald

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

144316 Issued in IL

Practice address

126 Delaware Dr
Bolingbrook, IL 60440-2368

Phone

(630) 991-8556

NPI assigned

Sep 13, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Anesthesia Associates, LTD

  • Pain Medicine (Anesthesiology) Physician
  • Aurora, IL
  • NPI 1952308223
  Medicare reassignment NPD

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1497425326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 DELAWARE DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402368",
            "telephone_number": "630-991-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 DELAWARE DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402368",
            "telephone_number": "630-991-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWALD",
        "first_name": "SAMANTHA",
        "middle_name": "LARUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041430338",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "144316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grateful Guidance Counseling and Coaching, PLLC
• Kenneth C Gray Sr., P.H.D,M.D., N.D.
• Melissa Angela Gray, MSW
• Andrea Green, MD
• Kayla Lynette Greene
• Tamara Jayne Greiff
• Sara Griffin, DPT
• Mary M. Grimwood, O.D.
• Susan Groetsch
• Alex Gu

• Certified Registered Nurse Anesthetist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.