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ST CLAIR SPECIALTY PHYSICIANS
NPI 1063719292
Internal Medicine - Nephrology in Boise, ID

Active since February 24, 2011CLIA Certified · 2 labs
5610 GAGE STREET, SUITE A, BOISE, ID 83706(208) 367-3370 Get Directions Write a Review

NPPES record last updated: February 24, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About St Clair Specialty Physicians NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST CLAIR SPECIALTY PHYSICIANS (NPI 1063719292) is a healthcare organization registered as a nephrology in Boise, Idaho and active in the NPI registry since February 2011. The organization holds 2 active CLIA laboratory certificates and lists Robert Provenzano, President/partner, as its authorized official.

NPPES Registry Identity

NPI1063719292
Entity TypeOrganization
Primary Taxonomy207RN0300X
Legal Business NameST CLAIR SPECIALTY PHYSICIANS
Location Address5610 GAGE STREET, SUITE ABoise, ID 83706
Mailing Address45640 Schoenherr RoadShelby Twp, MI 48315 · (586) 247-4300 · Fax (586) 532-6496
Phone(208) 367-3370
Organization SubpartNo
Authorized OfficialRobert ProvenzanoPresident/partner · (313) 886-8787
Enumeration DateFebruary 24, 2011
✔ NPI 1063719292 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
5610 GAGE STREET, Boise, ID 83706
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D0370884

St Clair Specialty Physicians · Detroit, MI
Active · expires May 13, 2027
CLIA Number23D0370884
Laboratory TypePhysician Office
Certificate Effective DateMay 14, 2025
Certificate Expiration DateMay 13, 2027
Laboratory DirectorQuresh T. Khairullah
Laboratory Phone(313) 886-8787
Laboratory LocationSt Clair Specialty Physicians22201 Moross Road Suite 170, Detroit, MI 48236
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D1003167

St Clair Specialty Physicians · Shelby Township, MI
Active · expires May 7, 2028
CLIA Number23D1003167
Laboratory TypePhysician Office
Certificate Effective DateMay 8, 2026
Certificate Expiration DateMay 7, 2028
Laboratory DirectorDr. Jukaku S. Tayeb
Laboratory Phone(586) 247-7800
Laboratory LocationSt Clair Specialty Physicians45650 Schoenherr, Shelby Township, MI 48315
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St Clair Specialty Physicians's NPI number?

The NPI number for St Clair Specialty Physicians is 1063719292. It was assigned to this organization in the NPPES registry on February 24, 2011.

Where is St Clair Specialty Physicians located?

St Clair Specialty Physicians is located at 5610 Gage Street Suite A, Boise, ID 83706. The listed phone number is (208) 367-3370.

What is St Clair Specialty Physicians's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Does St Clair Specialty Physicians hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for St Clair Specialty Physicians was last updated on February 24, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.