Individual provider Active NPI

Kathryn Provonche, PA

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1790236644
Registry record updated Feb 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4755 Ogletown Stanton Rd Ste 5A43
Newark, DE 19718-2200
Phone
(302) 623-0188
NPI assigned
Oct 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd Ste 5A43
Newark, DE 19718-2200

Mailing address

200 Hygeia Dr Ste 2300
Newark, DE 19713-2049

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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

Enrollment IDStateProvider typePAC IDDetails
I20180830002693 DE Practitioner - Physician Assistant 5496005167 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Infectious Disease Associates PAGroup PAC ID 1052337201, 12 clinicians
Infectious Disease Consultants PAGroup PAC ID 4183615081, 9 clinicians

Practice addresses (Care Compare)

33 Omega Dr
BLDG J
Newark, DE 19713-2058
Phone (302) 368-2883

537 Stanton Christiana Rd
Suite 201
Newark, DE 19713-2145
Phone (302) 994-9692

Hospital & facility affiliations

  • Christiana Hospital Hospital, Newark, DE, CCN 080001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Aug 12, 2018 Accepting new patients
Christiana Care Health Services Inc CurrentSince Aug 12, 2018 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Ste 5A43
Newark, DE 19718
Phone (302) 623-0188

200 Hygeia Dr
Ste 2300
Newark, DE 19713
Phone (302) 623-7362

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1476576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551312000000",
    "number": "1790236644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HYGEIA DR STE 2300",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197132049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 5A43",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-623-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVONCHE",
        "first_name": "KATHRYN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-16",
        "last_updated": "2019-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.