Stephen C Provenza (NPI# 1124113998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider Identifier (NPI) | 1124113998 |
| Entity Type | Individual |
| Full Name | Stephen C Provenza |
| Credential | PA |
| Gender | Male |
| Practice Address |
745 N Swope St Greenfield IN 46140 |
| Practice Telephone | 3174629221 |
| Practice Fax Number | 3174623400 |
| Mailing Address |
2741 W Layton Ave Ste 106 Milwaukee WI 53221-2600 |
| Mailing Telephone | 4142425468 |
| Mailing Fax Number | 8887240875 |
| Sole Proprietor | No, this individual is not a Sole Proprietor |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-03-08 |
| Primary | Taxonomy | Classification | Taxonomy Group | License Number | State |
|---|---|---|---|---|---|
| Yes | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | 10001076A | IN |
| State | Identifier | Issuer | Type Code |
|---|---|---|---|
| FL | 97020793 | OTHER | RAILROAD MEDICARE |
| IN | IN3848006 | OTHER | MEDICARE |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2502 25th St, Columbus, IN 472013728 | 8123728883 | 8123728964 |
| NPI | 1124113998 |
| PAC ID by PECOS | 5395056261 |
| Professional Enrollment ID | I20150618001377 |
| Full Name | Stephen Provenza |
| Organization Legal Name | GRIESEMER CHIROPRACTIC, LLC |
| Phone Number | 3178819792 |
| Gender | M |
| Medical School | MEDICAL COLLEGE OF GEORGIA |
| Graduation Year | 2001 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 9830371731 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356963961 | Anna Turner | Physician Assistant | 1287 Capstone Dr, Greenfield, IN 46140-2676 | 2020-05-18 |
| 1891334926 | Amber Davidson | Physician Assistant | 739 Lynn Point Rd, Greenfield, TN 38230-4003 | 2020-01-06 |
| 1356520720 | Jyoti J. Zaveri | Physician Assistant | 300 E Boyd Ave Ste 100, Greenfield, IN 46140-2816 | 2007-11-01 |
| 1538172697 | David Jeffrey Wilbert | Physician Assistant | 801 S Meridian St, Greenfield, TN 38230-2104 | 2006-08-13 |
| 1902878242 | Annah C Houk | Physician Assistant | 6901 W Edgerton Ave, Greenfield, WI 53220-4420 | 2006-02-02 |
| 1235115213 | Mark Steven Clark | Physician Assistant | 1 Verney Drive, Greenfield, NH 03047 | 2005-12-21 |
| 1265418826 | Stephen Pasquini | Physician Assistant | 467 El Camino Real, Greenfield, CA 93927-4915 | 2005-12-15 |
| 1386206233 | Lea Z Sack | Physician Assistant | 6901 W Edgerton Ave, Greenfield, WI 53220-4420 | 2019-07-01 |
| 1124689666 | Jenna M Mineau | Physician Assistant | 9000 W Sura Ln, Greenfield, WI 53228-3477 | 2019-06-25 |
| 1386204428 | David Finn Olcott | Physician Assistant | 329 Conway St, Greenfield, MA 01301-1521 | 2019-06-20 |
| Find all providers in GREENFIELD | ||||
| Street Address |
745 N SWOPE ST |
| City | GREENFIELD |
| State | IN |
| Zip Code | 46140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063468676 | Hendricks County Hospital | Skilled Nursing Facility | 745 N Swope St, Greenfield, IN 46140-1332 | 2006-05-25 |
| 1467051730 | Informe Healthcare Specialists, LLC | Counselor | 745 N Swope St, Greenfield, IN 46140-1332 | 2020-10-19 |
| 1417583220 | Progressive Care Solutions of In, LLC | Clinic/Center | 745 N Swope St, Greenfield, IN 46140-1332 | 2020-03-13 |
| 1730622291 | Dycora Transitional Health - Greenfield LLC | Skilled Nursing Facility | 745 N Swope St, Greenfield, IN 46140-1332 | 2016-11-30 |
| 1700335437 | Nancy Ellen Eaton | Nurse Practitioner | 745 N Swope St, Greenfield, IN 46140 | 2016-09-22 |
| 1346608049 | Joven Medical Group LLC | Family Medicine | 745 N Swope St, Greenfield, IN 46140-1332 | 2016-02-09 |
| 1114182383 | Tisha Stine | Occupational Therapist | 745 N Swope St, Greenfield, IN 46140-1332 | 2008-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417504655 | Megan Snider | Nurse Practitioner | 1120 S Jacobi Rd, Greenfield, IN 46140 | 2019-08-22 |
| 1598319048 | Paul Vernon Runyan Jr. | Counselor | 5486 W Us Highway 40, Greenfield, IN 46140 | 2019-08-01 |
| 1467928457 | Candace Kay Roudebush | Developmental Therapist | 1342 Fairview Dr, Greenfield, IN 46140 | 2018-10-17 |
| 1730660481 | Samruddhi Dawande | Physical Therapist | 200 Green Meadows Drive, Greenfield, IN 46140 | 2018-08-21 |
| 1255794178 | Claire Lubbers | Nurse Practitioner | 300 E. Boyd Ave., Suite Ahn-family Medicine, Greenfield, IN 46140 | 2016-03-29 |
| 1376905752 | Justin Donat | Pharmacist | 2181 N West Bay Dr Apt D, Greenfield, IN 46140 | 2016-03-24 |
| 1265716476 | Kathleen Theresa Picard-nance | Pharmacist | 1195 N State Street, Greenfield, IN 46140 | 2011-10-06 |
| 1780991513 | Melinda Sue Wolfe | Midwife, Lay | 1929 Declaration Dr, Greenfield, IN 46140 | 2010-08-31 |
| 1669694287 | Lifetime Dental Care of Indiana, PC | Dentist | 168 East New Road, Greenfield, IN 46140 | 2007-05-03 |
| 1790903177 | Christina Renee Mcqueeney | Audiologist | 1834 Fields Blvd, Greenfield, IN 46140 | 2007-04-23 |
| Find all providers in zip 46140 | ||||
| City | GREENFIELD |
| Zip Code | 46140 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.