Samantha Denise Broadwater, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN270598 Issued in GA

Practice address

901 18TH St E
Tifton, GA 31794-3648

Phone

(229) 382-7120

NPI assigned

Jun 26, 2021

Last updated

Jul 31, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tift Regional Health System Inc

  dba Southwell Mobile Clinic

  • Family Medicine Physician
  • Tifton, GA
  • NPI 1881203305
  Medicare reassignment NPD
• Tift Regional Health System Inc

  dba WorkSmart Occupational Medicine

  • Clinic/Center
  • Tifton, GA
  • NPI 1003980996
  NPD
• Tift Regional Health System Inc.

  dba Tift Regional Medical Center

  • General Acute Care Hospital
  • Tifton, GA
  • NPI 1962462226
  NPD

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

{
    "created_epoch": "1624665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1568032274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-7120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4090 Old Ga Highway 3",
            "address_purpose": "LOCATION",
            "city": "Camilla",
            "state": "GA",
            "postal_code": "317306341",
            "country_code": "US",
            "telephone_number": "229-319-6291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "SAMANTHA",
        "middle_name": "DENISE",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-26",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN270598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Monk Boyett, CCC-SLP
• Parviz Brahman, M.D.
• Judith B Branch, CCC-SLP
• J Scott Brickman, M.D.
• Sandra Gail Brickman, M.D.
• Belinda Kay Brock, LPC009749
• Margaret Anne Brock
• Courtney Brooke, NP
• Lee Michelle Brooks, LCSW
• Dale Broome, PA

• Certified Registered Nurse Anesthetist in Tifton, GA
• Providers in Tifton, GA by specialty
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.