NPIMap

Individual provider Active NPI

Jerome A Provenzano, MD

  • Family Medicine Physician
  • Newport News, VA
National Provider Identifier
1891760039
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101048791 Issued in VA
Practice address
12655 Warwick Blvd
Newport News, VA 23606-2501
Phone
(757) 595-9880
Fax
(757) 595-0362
NPI assigned
Feb 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101048791 VA Primary

Addresses

Primary practice location

12655 Warwick Blvd
Newport News, VA 23606-2501

Mailing address

860 Omni Blvd Ste 101
Newport News, VA 23606-4430
Phone (757) 232-8769

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20060630000109 VA Practitioner - Family PracticePractitioner - Emergency Medicine 3971515388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Georgetown University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
James River Family Practice LLCGroup PAC ID 6103977616, 3 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

11835 Fishing Point Dr
Suite 104
Newport News, VA 23606-2584
Phone (757) 599-5588

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

  • Commonwealth Home Care Home health agency, Portsmouth, VA, CCN 497775
  • Bridge Hospice Hospice, Glen Allen, VA, CCN 491577
  • Riverside Regional Medical Center Hospital, Newport News, VA, CCN 490052
  • Sentara Careplex Hospital Hospital, Hampton, VA, CCN 490093
  • Riverside Walter Reed Hospital Hospital, Gloucester, VA, CCN 490130
  • Sentara Williamsburg Regional Medical Center Hospital, Williamsburg, VA, CCN 490066

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101048791VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
James River Family Practice, LLC Family Medicine CurrentSince Sep 17, 2023 Accepting new patients
James River Family Practice, LLC Family Medicine Past Accepting new patients

Locations

1007 N Federal Hwy
Ft Lauderdale, FL 33304
Phone (954) 336-7722

11835 Fishing Point Dr
Ste 104
Newport News, VA 23606
Phone (757) 246-3146

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Traditions HealthGlen Allen, VA, CCN 491577 Hospice W-2 Managing Employee Dec 3, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 6

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1891760039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 101",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8769",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12655 WARWICK BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236062501",
            "telephone_number": "757-595-9880",
            "fax_number": "757-595-0362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "JEROME",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101048791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

Verify at the official NPI Registry.