MS. SAMANTHA DENISE BROADWATER CRNA
NPI 1568032274
Nurse Anesthetist, Certified Registered in Tifton, GA

Q: What is Samantha Broadwater's NPI number?

The NPI number for Samantha Broadwater is 1568032274. It was assigned to this individual provider in the NPPES registry on June 26, 2021.

Q: What is Samantha Broadwater's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Active since June 26, 2021

901 18TH ST E, TIFTON, GA 31794(229) 382-7120 Get Directions Write a Review

NPPES record last updated: July 31, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Ms. Samantha Denise Broadwater Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. SAMANTHA DENISE BROADWATER CRNA (NPI 1568032274) is an individual nurse anesthetist, certified registered in Tifton, Georgia, licensed in Georgia (RN270598) and active in the NPI registry since June 2021. She maintains a secondary practice location in Camilla.

NPPES Registry Identity

NPI1568032274

Entity TypeIndividualFemale

Primary Taxonomy367500000X

Provider Legal NameMS. SAMANTHA DENISE BROADWATERCredential: CRNA

Location Address901 18TH ST ETifton, GA 31794-3648

Mailing Address901 18th St ETifton, GA 31794-3648 · (229) 382-7120

Phone(229) 382-7120

Sole ProprietorNo

Enumeration DateJune 26, 2021

Last NPPES UpdateJuly 31, 2023

NPPES CertifiedJuly 31, 2023

✔ NPI 1568032274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in GA · RN270598

Definition

(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.

901 18TH ST E, Tifton, GA 31794

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Secondary Practice Location 1

Location 14090 Old Ga Highway 3Camilla, GA 31730-6341 · Phone (229) 319-6291

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Samantha Denise Broadwater Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Samantha Broadwater reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Tift Regional Health System Inc.

Same address

General Acute Care Hospital

901 18TH ST E
Tifton, GA 31794

Reassigned Medicare billing, Georgia enrollment
380 clinicians in this Medicare group

NPI 1962462226 (229) 382-7120

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COLE BURGESS CRNA

Nurse Anesthetist, Certified Registered