Kacey Helena Provenzano, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD60964556 Issued in WA

Practice address

780 Swift Blvd Ste 201
Richland, WA 99352

Phone

(509) 942-3288

Fax

(509) 942-3167

NPI assigned

Apr 3, 2013

Last updated

Jun 23, 2021By the provider in NPPES

Sex

Female

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

Eligible to order & refer

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

Green means eligible to order or refer.

Specialty

Urology

Education

University of Kansas School of Med (KC/Wich/Sal), 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kadlec Regional Medical Center Hospital, Richland, WA, CCN 500058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kprovenzano1109758@wm.providencedirect.org

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.

• Kadlec Regional Medical Center

  dba Kadlec Regional Medical Center - Rehab Unit

  • Rehabilitation Hospital Unit
  • Richland, WA
  • NPI 1790319580
  NPD
• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  NPD

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

• Kadlec Regional Medical Center

  • General Acute Care Hospital
  • Richland, WA
  • NPI 1972507580
  Care Compare affiliation

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1740523158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 GAGE BLVD STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993529532",
            "telephone_number": "509-942-3288",
            "fax_number": "509-942-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 SWIFT BLVD STE 201",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "99352",
            "telephone_number": "509-942-3288",
            "fax_number": "509-942-3167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 Burlington Mall Rd Mailstop 201Fl3",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "MA",
            "postal_code": "018051473",
            "country_code": "US",
            "telephone_number": "781-901-0836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "KACEY",
        "middle_name": "HELENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-03",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MA",
            "license": "264720",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD60964556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kprovenzano1109758@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "780 Swift Blvd Ste 201",
            "city": "Richland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "99352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Prescription Pharmacy
• Prescription Pharmacy PLLC (RX Pharmacy)
• Present Mind Counseling PLLC
• Private Healthcare Facilities
• Proliance Surgeons, Inc., P.S. (Northwest Orthopaedic and Sports Medicine)
• Providence Health & Services (Providence Spokane Heart Institute-Richland)
• Psychological Consultants, Inc.
• Nadean Marie Pulfer, PA-C
• Elizabeth Dorine Purkeypyle, SUDPT
• Purple Rose Counseling

• Urology Physician in Richland, WA
• Providers in Richland, WA by specialty
• Urology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.