NPIMap

Individual provider Active NPI

David Gerard Provaznik, DO

  • Family Medicine Physician
  • Wheelersburg, OH
National Provider Identifier
1245267624
Registry record updated Feb 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34005337 Issued in OH
Practice address
11826 Gallia Pike
Suite a
Wheelersburg, OH 45694-9119
Phone
(740) 574-4526
Fax
(740) 574-2895
NPI assigned
Jun 28, 2006
Last updated
Feb 12, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34005337 OH Primary

Addresses

Primary practice location

11826 Gallia Pike
Suite a
Wheelersburg, OH 45694-9119

Mailing address

PO Box 2379
Ashland, KY 41105-2379
Phone (740) 574-4526

Other identifiers 1

IdentifierTypeStateIssuer
0842315MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20091230000638 OH Practitioner - Family Practice 8729080684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier Therapy and Health Centers IncGroup PAC ID 7416859574, shared by 6 NPIs, 263 clinicians

Practice addresses (Care Compare)

11826 Gallia Pike Rd a
Wheelersburg, OH 45694-9119
Phone (740) 574-4526

1242 Crescent Dr
Wheelersburg, OH 45694-9376
Phone (740) 574-8441

1805 27TH St
Portsmouth, OH 45662-2640
Phone (740) 356-5000

1901 Argonne Rd
Portsmouth, OH 45662-2827
Phone (740) 353-1978

7700 Ohio River Rd
Suite B
Wheelersburg, OH 45694-1653
Phone (740) 574-4616

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.04 of 100Reported as group
Quality
60.55
Promoting interoperability
100
Improvement activities
40
Cost
78.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
34005337OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kings Daughters Medical Specialties Inc Current Accepting new patients
Kings Daughters Medical Specialties Inc Family Medicine CurrentSince Mar 14, 2011 Accepting new patients
Kings Daughters Medical Specialties Inc CurrentSince Mar 14, 2011 Accepting new patients
David G Provaznik DO Inc Family Medicine CurrentSince Jul 2, 2016 Accepting new patients
Southern Ohio Medical Center Past Accepting new patients
Edgewood Manor of Lucasville I LLC Past Accepting new patients
Wheelersburg Health Care Center, Inc. Past Accepting new patients
Portsmouth Hospital Corporation Family Medicine Past Accepting new patients
Edgewood Manor of Lucasville II LLC Past Accepting new patients
Kings Daughters Medical Specialties Inc Past Accepting new patients

Locations

1805 27th St
Portsmouth, OH 45662
Phone (740) 356-5000

11826 Gallia Pike
Ste A
Wheelersburg, OH 45694
Phone (740) 574-0600

1242 Crescent Dr
Wheelersburg, OH 45694
Phone (740) 574-8441

Interoperability endpoints

  • Direct secure messaging: david.provaznik@somc.medicity.net
  • Direct secure messaging: dprovaznik11213@direct.kdhealth.us

Organizations & group practices 10

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.

Hospital & facility affiliations 9

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392163200000",
    "number": "1245267624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2379",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411052379",
            "telephone_number": "740-574-4526",
            "fax_number": "740-574-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11826 GALLIA PIKE",
            "address_2": "SUITE A",
            "city": "WHEELERSBURG",
            "state": "OH",
            "postal_code": "456949119",
            "telephone_number": "740-574-4526",
            "fax_number": "740-574-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVAZNIK",
        "first_name": "DAVID",
        "middle_name": "GERARD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2014-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34005337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0842315",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheelersburg, OH

Sources for this page

Verify at the official NPI Registry.