Lisa Provenzano, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704150069 Issued in MI

Practice address

359 Enterprise CT SPC B
Bloomfield Hills, MI 48302-1055

Phone

(248) 751-7246

Fax

(248) 418-2311

NPI assigned

Jan 3, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Neuro Pain Consultants PCGroup PAC ID 1052204062, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• McLaren Oakland Hospital, Pontiac, MI, CCN 230207

Merit-based Incentive Payment System (MIPS)

Final score

75.88 of 100Reported as group

Quality

45.07

Promoting interoperability

96

Improvement activities

40

Cost

77.86

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisa.provenzano.1@15471.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/15471/brand/1/csg/1/fhir/r4

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.

• Neuro Pain Consultants PC

  • Pain Medicine (Anesthesiology) Physician
  • Bloomfield Hills, MI
  • NPI 1417936584

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McLaren Oakland

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1376564088
  Care Compare affiliation

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1609051135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "359 ENTERPRISE CT SPC B",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483021055",
            "telephone_number": "248-751-7246",
            "fax_number": "248-418-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 ENTERPRISE CT SPC B",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483021055",
            "telephone_number": "248-751-7246",
            "fax_number": "248-418-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "LISA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-03",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704150069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Primary Care Services PC
• Progressive Residential Services, Inc.
• Project Home Health
• Prompt Care Home Health Services, Inc.
• Prosperity Health PC
• Thomas Michael Pullman, DR OF DENTAL SURGERY
• Simi Pullukat, M.D.
• Pure Joy Pediatrics, P.C.
• Kasturi B Puri, M.D
• Purple Orchid, LLC

• Nurse Practitioner in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.