Kaynessa Celena Providence, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

86204 Issued in GA

Practice address

54 Tower Rd NE
Marietta, GA 30060-6977

Phone

(770) 427-4682

Fax

(770) 499-8562

NPI assigned

Apr 10, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Georgia Mso LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1952196164
  Medicare reassignment NPD
• Hardy Renew Wellness,LLC

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1952914368
  Medicare reassignment NPD
• Marietta Ga Opco LLC

  • Skilled Nursing Facility
  • Marietta, GA
  • NPI 1699494104
  NPD (past)
• Sandy Springs Center for Nursing and Healing LLC

  • Skilled Nursing Facility
  • Atlanta, GA
  • NPI 1104568666
  NPD (past)

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1013303650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 TOWER RD NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606977",
            "telephone_number": "770-427-4682",
            "fax_number": "770-499-8562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 TOWER RD NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606977",
            "telephone_number": "770-427-4682",
            "fax_number": "770-499-8562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Ralph David Abernathy Blvd SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303101649",
            "country_code": "US",
            "telephone_number": "404-836-0136",
            "fax_number": "404-753-5266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVIDENCE",
        "first_name": "KAYNESSA",
        "middle_name": "CELENA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-10",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "86204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kprovidence491264@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "54 Tower Rd NE",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300606977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Torre Marsha Prothro, PHD
• Provectus Health Strategies, LLC
• Allex Provens, MA
• Providence Dental Spa of East Cobb, LLC
• Providence Rd Primary Care LLC
• Provident Healthcare LLC
• Sandra L Pruett, CNP
• Lashanti Melba Pruitt, MA
• Pruitthealth - Marietta, LLC
• Pruittplace - East Cobb, LLC

• Internal Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.