John Marc Provenzano, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

6183 Issued in NC

Practice address

5841 S Maryland Ave
Chicago, IL 60637-1447

Phone

(773) 702-6700

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jprovenzano758680@direct.novanthealth.org

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.

• The Moses H Cone Memorial Hospital Operating Corporation

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1356372064
  NPD
• The Moses H Cone Memorial Hospital Operating Corporation

  • Community/Retail Pharmacy
  • Eden, NC
  • NPI 1861222507
  NPD
• The Moses H. Cone Memorial Hospital Operating Corporation

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1013265909
  NPD

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676592000000",
    "number": "1437129335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1042 RIVEROAKS CT",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273177987",
            "telephone_number": "630-607-9949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-702-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "JOHN",
        "middle_name": "MARC",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209001255",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "6183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JPROVENZANO758680@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "5841 S Maryland Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606371447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Protalk
• Marvin Craig Protasio, PHARMD
• Desiree Michelle Provax, APN
• Proven Behavioral Health
• Deborah Provenzano, SLPA
• Proverbs 3 PC
• Proverbs 3 PC
• Tim S. Provias, M.D.
• Providence Center
• Providence Homecare Services Inc

• All providers in Chicago, IL
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.