Christian Provenza

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

License

01096646A Issued in IN

Practice address

1120 West Michigan Street
Gatch Hall Office CL 285
Indianapolis, IN 46202

Phone

(317) 278-0042

NPI assigned

Mar 9, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: cprovenza24529@mlh.direct-ci.com

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752192000000",
    "number": "1659906741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 WEST MICHIGAN STREET",
            "address_2": "GATCH HALL OFFICE CL 285",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 WEST MICHIGAN STREET",
            "address_2": "GATCH HALL OFFICE CL 285",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202",
            "telephone_number": "317-278-0042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1265 Union Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381043415",
            "country_code": "US",
            "telephone_number": "901-516-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "877 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381032807",
            "country_code": "US",
            "telephone_number": "901-545-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVENZA",
        "first_name": "CHRISTIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-09",
        "last_updated": "2025-07-11",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "67438",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IN",
            "license": "01096646A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stella Protopapas, MD, MPH
• Gretchen Sophia Prout
• John William Prout III, PHARMD
• Elizabeth J Proven, M.A., CCC-SLP
• Mary Anita Provence, LCSW
• Providence Medical Associates LLC
• Providing Ease at Home Care Services, LLC
• Providing Ease Home Health, LLC
• Meredith Price Provost, MD
• Nancy K Pruett, D.D.S.

• Critical Care Medicine (Internal Medicine) Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Critical Care Medicine (Internal Medicine) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.