NPIMap

Individual provider Active NPI

Anthony Provenzano

  • Nephrology Physician
  • Greenville, NC
National Provider Identifier
1710371091
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
2019-01052 Issued in NC
Practice address
511 Paladin Dr
Greenville, NC 27834-7826
Phone
(252) 752-8880
Fax
(252) 317-2092
NPI assigned
Mar 24, 2015
Last updated
Sep 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 2019-01052 NC Primary

Addresses

Primary practice location

511 Paladin Dr
Greenville, NC 27834-7826

Mailing address

511 Paladin Dr
Greenville, NC 27834-7826
Phone (252) 752-8880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20200530000075 NC Practitioner - NephrologyPractitioner - Internal Medicine 9537461355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Wayne State University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Eastern Nephrology Associates PLLCGroup PAC ID 2264420512, 75 clinicians

Practice addresses (Care Compare)

118 Avon Ave
Suite 105
Washington, NC 27889-3870
Phone (225) 975-1789

222 Virginia Rd
Unit C
Edenton, NC 27932-9667
Phone (252) 752-8880

3800 E 10TH St
Suite 102
Greenville, NC 27858-7618
Phone (252) 752-8880

511 Paladin Dr
Greenville, NC 27834-7826
Phone (252) 752-8880

608 A Airport Rd
Kinston, NC 28504-8210
Phone (252) 523-8513

970 Newman Rd
New Bern, NC 28562-5200
Phone (252) 633-9262

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Nephrology Associates PLLC Nephrology CurrentSince Jul 13, 2020 Accepting new patients

Locations

222 Virginia Rd
Unit C
Edenton, NC 27932

511 Paladin Dr
Greenville, NC 27834
Phone (252) 317-2280

608 Airport Rd
Ste A
Kinston, NC 28504

1314 Highland Dr
Washington, NC 27889
Phone (252) 948-0101

Interoperability endpoints

  • Direct secure messaging: aprovenzano23534@direct.acumenmd.com

Organizations & group practices 1

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 8

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": "1427155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1710371091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 PALADIN DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347826",
            "telephone_number": "252-752-8880",
            "fax_number": "252-317-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 PALADIN DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347826",
            "telephone_number": "252-752-8880",
            "fax_number": "252-317-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "ANTHONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-24",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "2019-01052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.