NPIMap

Individual provider Active NPI

Christopher Robert Provenzano, MD

  • Nephrology Physician
  • Shelby Township, MI
National Provider Identifier
1982876157
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301082092 Issued in MI
Practice address
45650 Schoenherr Rd
Shelby Township, MI 48315-6033
Phone
(586) 286-7800
Fax
(586) 286-7804
NPI assigned
Mar 28, 2008
Last updated
Oct 27, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 4301082092 MI Primary
Hypertension Specialist Physician 207RH0005X 4301082092 MI
Nephrology Physician 207RN0300X 49048 CO

Addresses

Primary practice location

45650 Schoenherr Rd
Shelby Township, MI 48315-6033

Mailing address

45640 Schoenherr Rd
Suite B
Shelby Township, MI 48315-6033
Phone (586) 247-4300

Other identifiers 1

IdentifierTypeStateIssuer
CP4301082092OtherMISTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20080630000713 MI Practitioner - NephrologyPractitioner - Internal Medicine 8628140050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Clair Specialty Physicians PCGroup PAC ID 6204733256, 36 clinicians

Practice addresses (Care Compare)

18001 E 10 Mile Rd
Roseville, MI 48066-3803
Phone (586) 871-3686

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Specialty Physicians Nephrology Current Accepting new patients
St Clair Specialty Physicians PC Nephrology CurrentSince Jul 1, 2008 Accepting new patients
Detroit Kidney Care, P.C. Nephrology Past Accepting new patients

Locations

4180 Hospital Dr
East China, MI 48054
Phone (313) 800-8230

46591 Romeo Plank Rd
Macomb, MI 48044
Phone (586) 226-6269

515 W Jefferson St
Petoskey, MI 49770
Phone (231) 348-5622

2603 Electric Ave
Ste D
Port Huron, MI 48060
Phone (810) 987-5252

18001 E 10 Mile Rd
Roseville, MI 48066
Phone (586) 218-5800

18001 E 10 Mile Rd
Ste 1
Roseville, MI 48066
Phone (586) 218-5800

23857 Greenfield Rd
Southfield, MI 48075
Phone (248) 569-6111

45640 Schoenherr Rd
Utica, MI 48315
Phone (586) 247-4300

45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300

45650 Schoenherr Rd
Utica, MI 48315
Phone (586) 286-7800

Interoperability endpoints

  • Direct secure messaging: christopherprovenzano@stclairspe.allscriptsdirect.net
  • Direct secure messaging: cprovenzano63414@direct.hfhs.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1206662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1982876157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45640 SCHOENHERR RD",
            "address_2": "SUITE B",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156033",
            "telephone_number": "586-247-4300",
            "fax_number": "586-532-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45650 SCHOENHERR RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483156033",
            "telephone_number": "586-286-7800",
            "fax_number": "586-286-7804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "CHRISTOPHER",
        "middle_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-28",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301082092",
            "primary": true
        },
        {
            "code": "207RH0005X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hypertension Specialist",
            "state": "MI",
            "license": "4301082092",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CO",
            "license": "49048",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "CP4301082092",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

Verify at the official NPI Registry.