St Clair Specialty Physicians PC
NPI 1154361616ActiveOrganization· Internal Medicine, Nephrology· Roseville, MI
Internal Medicine, Nephrology in Roseville, Michigan, registered in NPPES in June 2006. The authorized official on file is Christopher Robert Provenzano, MD, Ceo/Managing Employee (W2). Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1154361616 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 6, 2006 |
| Last updated in NPPES | Oct 17, 2022 |
| Certified by provider | Oct 17, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine, Nephrology Primary | 207RN0300X | — | — |
| Surgery, Vascular Surgery | 2086S0129X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (ID); Part B Supplier - Clinic/Group Practice (MI); Part B Supplier - Clinic/Group Practice (OR) |
|---|
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