NPIMap

Individual provider Active NPI

Samantha Nowak, PA-C

  • Physician Assistant
  • Johnstown, CO
National Provider Identifier
1801140223
Registry record updated May 23, 2025
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Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8956 Issued in CO
Practice address
4435 Ronald Reagan Blvd
Johnstown, CO 80534-6566
Phone
(970) 619-8139
NPI assigned
Nov 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6653 GA
Physician Assistant 363A00000X 8956 CO Primary

Addresses

Primary practice location

4435 Ronald Reagan Blvd
Johnstown, CO 80534-6566

Mailing address

4435 Ronald Reagan Blvd
Johnstown, CO 80534-6566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250714003986 CO Practitioner - Physician Assistant 2769635127 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Hospital Based Physicians Colorado LLCGroup PAC ID 6800031386, 82 clinicians

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4593

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
8956COMDGeneral Practice Dentistry
6653GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Aug 1, 2025 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Aug 1, 2025 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Aug 1, 2025 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Aug 1, 2025 Accepting new patients
Thompson River Pediatrics and Urgent Care, LLC Past Accepting new patients

Locations

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

Organizations & group practices 6

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.

Hospital & facility affiliations 12

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": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1801140223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4435 RONALD REAGAN BLVD",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "805346566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 RONALD REAGAN BLVD",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "805346566",
            "telephone_number": "970-619-8139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOWAK",
        "first_name": "SAMANTHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-07",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "6653",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "8956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, CO

Sources for this page

Verify at the official NPI Registry.