Kathleen Michelle Provanzana, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35071152P Issued in OH

Practice address

6 Lexington Blvd
Delaware, OH 43015-1047

Phone

(740) 363-3305

Fax

(740) 383-7942

NPI assigned

Jun 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Family Practice

Education

Ohio State University College of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.04 of 100Reported as group

Quality

58.67

Promoting interoperability

98

Improvement activities

40

Cost

76.46

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ohiohealth Corporation

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1578545273
  Medicare reassignment Care Compare group NPD
• Marion Area Physicians LLC

  • Internal Medicine Physician
  • Marion, OH
  • NPI 1619230802

  Family Medicine

  Medicare reassignment NPD
• Ohiohealth Corporation

  • Anesthesiology Physician
  • Columbus, OH
  • NPI 1407292105
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1891736013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 LEXINGTON BLVD",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430151047",
            "telephone_number": "740-363-9021",
            "fax_number": "740-363-7962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 LEXINGTON BLVD",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430151047",
            "telephone_number": "740-363-3305",
            "fax_number": "740-383-7942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "697 Thomas Ln",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432143931",
            "country_code": "US",
            "telephone_number": "614-566-5414",
            "fax_number": "614-533-0433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVANZANA",
        "first_name": "KATHLEEN",
        "middle_name": "MICHELLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35071152P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2025334",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID PHYS AND NON PHYS",
            "identifier": "311098079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "311098079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "311098079240",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "0104351",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVELERS MEDICARE",
            "identifier": "080122321",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2074133",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE",
            "identifier": "0855442",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBMITTER NO.",
            "identifier": "353077",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kprovanzana91893@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group",
            "address_1": "6 Lexington Blvd",
            "city": "Delaware",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430151047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victoria Mylene Pridemore
• Tanice A Prince, LISW-S
• Prissy Home Health LLC
• Procare Vision Enter
• Arianna Profato, M.S.ED, PCC-S
• Kimberly Jo Pruitt, LPN
• Psychological Systems, Inc.
• Robert Allen Pugliese, M.D.
• Alexis Purdum
• Paul Que, D.M.D.

• Family Medicine Physician in Delaware, OH
• Providers in Delaware, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; 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.