Richard M Proenza, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

004304 Issued in GA

Practice address

3301 E 1St St
Suite a
Vidalia, GA 30474-8674

Phone

(912) 537-4411

Fax

(912) 538-8485

NPI assigned

Oct 20, 2005

Last updated

Oct 3, 2013By the provider in NPPES

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mark Spivey Orthopedic Clinic LLCGroup PAC ID 5395797336, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Health Meadows Hospital Hospital, Vidalia, GA, CCN 110128
• Optim Medical Center - Tattnall Hospital, Reidsville, GA, CCN 111323

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: rproenza@spiveyortho.emadirect.md

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.

• Mark Spivey Orthopedic Clinic, LLC

  • Orthopaedic Surgery Physician
  • Vidalia, GA
  • NPI 1104017821
  Medicare reassignment Care Compare group
• Memorial Health Urgentone, Inc.

  dba UrgentOne Savannah Mall

  • Emergency Medicine Physician
  • Savannah, GA
  • NPI 1801818844
  NPD (past)

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

• Tattnall Hospital Company, LLC

  dba Optim Medical Center - Tattnall

  • Critical Access Hospital
  • Reidsville, GA
  • NPI 1790942381
  Care Compare affiliation
• Vidalia Health Services, LLC

  • General Acute Care Hospital
  • Vidalia, GA
  • NPI 1790376564
  Care Compare affiliation

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1982693024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 E 1ST ST",
            "address_2": "SUITE A",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748674",
            "telephone_number": "912-537-4411",
            "fax_number": "912-538-8485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 E 1ST ST",
            "address_2": "SUITE A",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748674",
            "telephone_number": "912-537-4411",
            "fax_number": "912-538-8485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROENZA",
        "first_name": "RICHARD",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "004304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "954937257E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "954937257F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emma Elizabeth Pittman, PA-C
• Misty Denise Poole, M.D.
• Preferred Labs of Vidalia LLC
• Premise Health of Georgia Medical PC (Dot Vidalia Family Health Center)
• Elisabeth Ann Proenza, FNP-C
• Pruitthealth Home Health South Georgia, Inc (PruittHealth @ Home - Vidalia)
• Pruitthealth Home Health, Inc. (PruittHealth @ Home - Vidalia)
• Candice Stapleton Purvis, PA-C
• Miranda Leigh Quick, COTA
• Courtney O Ragan, FNP

• Surgical Physician Assistant in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.