NPIMap

Individual provider Active NPI

David Provenzano, MD

  • Interventional Pain Medicine Physician
  • Sewickley, PA
National Provider Identifier
1790796233
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
MD429974 Issued in PA
Practice address
301 Ohio River Blvd Ste 203
Sewickley, PA 15143-1300
Phone
(412) 221-7640
Fax
(412) 490-9850
NPI assigned
Aug 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 12812 NH
Pain Medicine (Anesthesiology) Physician 207LP2900X 12812 NH
Interventional Pain Medicine Physician 208VP0014X MD429974 PA Primary

Addresses

Primary practice location

301 Ohio River Blvd Ste 203
Sewickley, PA 15143-1300

Mailing address

301 Ohio River Blvd Ste 203
Sewickley, PA 15143-1300
Phone (412) 221-7640

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dprovenzano@pdic.medentdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20061004000519 PA Practitioner - Interventional Pain ManagementPractitioner - AnesthesiologyPractitioner - Pain Management 3870599491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology, Pain Management
Education
University of Rochester School of Medicine and Dentistry, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Rehab-Bray LLCGroup PAC ID 8527256460, 84 clinicians
Pain Diagnostics and Interventional Care LLCGroup PAC ID 6103050570, 5 clinicians
Mrs Physical TherapyGroup PAC ID 0042128407, 168 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

2716 Sunset Blvd
Steubenville, OH 43952-1155
Phone (740) 264-0772

301 Ohio River Blvd
Suite 203
Sewickley, PA 15143-1300
Phone (412) 221-7640

4538 Peach St
Erie, PA 16509-1364
Phone (814) 864-6650

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12812NHMDPain Medicine (Anesthesiology) Physician
MD429974PAMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Diagnostics & Interventional Care LLC Pain Medicine CurrentSince Sep 1, 2013 Accepting new patients
Regional Anesthesia Associates Past Accepting new patients
Windber Hospital, Inc. Anesthesiology Past Accepting new patients

Locations

301 Ohio River Blvd
Ste 203
Sewickley, PA 15143
Phone (412) 221-7640

6001 Stonewood Dr
Wexford, PA 15090
Phone (724) 933-3800

Interoperability endpoints

  • Direct secure messaging: dprovenzano@pdic.medentdirect.com

Organizations & group practices 5

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 12

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": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1790796233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 OHIO RIVER BLVD STE 203",
            "city": "SEWICKLEY",
            "state": "PA",
            "postal_code": "151431300",
            "telephone_number": "412-221-7640",
            "fax_number": "412-490-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 OHIO RIVER BLVD STE 203",
            "city": "SEWICKLEY",
            "state": "PA",
            "postal_code": "151431300",
            "telephone_number": "412-221-7640",
            "fax_number": "412-490-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NH",
            "license": "12812",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NH",
            "license": "12812",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "PA",
            "license": "MD429974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dprovenzano@pdic.medentdirect.com",
            "affiliation": "N",
            "endpointDescription": "dprovenzano@pdic.medentdirect.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "301 Ohio River Blvd Ste 203",
            "city": "Sewickley",
            "state": "PA",
            "country_code": "US",
            "postal_code": "151431300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sewickley, PA

Sources for this page

Verify at the official NPI Registry.