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ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES
NPI 1154361616
Internal Medicine - Nephrology in Roseville, MI

Active since June 06, 2006CLIA 23D2100285 · Microscopy
18001 E 10 MILE RD, SUITE 1, ROSEVILLE, MI 48066(586) 218-5800(586) 532-6496 Get Directions Write a Review

NPPES record last updated: October 17, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 17, 2022, May 16, 2016 (2 updates tracked since 2016).

About St. Clair Nephrology, Idaho Nephrology Associates NPPES

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

ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES (NPI 1154361616) is a healthcare organization registered as a nephrology in Roseville, Michigan and active in the NPI registry since June 2006. The organization holds a CLIA Microscopy certificate valid through August 11, 2027 and lists Christopher Robert Provenzano, Ceo/managing Employee (w2), as its authorized official.

NPPES Registry Identity

NPI1154361616
Entity TypeOrganization
Primary Taxonomy207RN0300X
Legal Business NameST CLAIR SPECIALTY PHYSICIANS PC
Location Address18001 E 10 MILE RD, SUITE 1Roseville, MI 48066-3803
Mailing Address45640 Schoenherr RdShelby Township, MI 48315-6033 · (586) 247-4300 · Fax (586) 532-6496
Phone(586) 218-5800
Fax(586) 532-6496
Organization SubpartNo
Authorized OfficialChristopher Robert ProvenzanoCeo/managing Employee (w2) · (586) 286-7800
Enumeration DateJune 6, 2006
Last NPPES UpdateOctober 17, 20222 updates tracked since enumeration
NPPES CertifiedOctober 17, 2022
✔ NPI 1154361616 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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.
Also ListedSurgery · Vascular SurgeryTaxonomy 2086S0129X
18001 E 10 MILE RD, Roseville, MI 48066
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Other Names 1

Doing Business AsSt. Clair Nephrology, Idaho Nephrology Associates

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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) 23D2100285

St Clair Specialty Physicians · Roseville, MI
Active · expires Aug 11, 2027
CLIA Number23D2100285
Laboratory TypePhysician Office
Certificate Effective DateAugust 12, 2025
Certificate Expiration DateAugust 11, 2027
Laboratory DirectorKeith Bellovich
Laboratory Phone(586) 218-5800
Laboratory LocationSt Clair Specialty Physicians18001 E 10 Mile Road Suite 1, Roseville, MI 48066
CLIA data matches this NPI record on: Address 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.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEATHER LYNN HENDERSON DO
Internal Medicine (Nephrology)
18001 E 10 MILE RD, SUITE 1
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
QURESH KHAIRULLAH MD
Internal Medicine (Nephrology)
18001 E 10 MILE RD, SUITE 1
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
SAMAH HALBOUNI SUEDE MD
Internal Medicine (Nephrology)
18001 E 10 MILE RD
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
MIRJANA DIMITRIJEVIC MD
Internal Medicine
18001 E 10 MILE RD
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
KEITH BELLOVICH DO
Internal Medicine (Nephrology)
18001 E 10 MILE RD, SUITE 1
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
MOHAMED EL-GHOROURY MD
Internal Medicine (Nephrology)
18001 E 10 MILE RD, SUITE 1
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
JENNIFER SIMPSON RUPRECHT PA
Physician Assistant
18001 E 10 MILE RD
ROSEVILLE, MI 48066
Macomb County (586) 218-5800
JUKAKU TAYEB MD
Internal Medicine (Nephrology)
18001 E 10 MILE RD, SUITE 1
ROSEVILLE, MI 48066
Macomb County (586) 218-5800

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 PC's NPI number?

The NPI number for St Clair Specialty Physicians PC is 1154361616. It was assigned to this organization in the NPPES registry on June 6, 2006. The provider is doing business as St. Clair Nephrology, Idaho Nephrology Associates.

Where is St Clair Specialty Physicians PC located?

St Clair Specialty Physicians PC is located at 18001 E 10 Mile Rd Suite 1, Roseville, MI 48066. The listed phone number is (586) 218-5800.

What is St Clair Specialty Physicians PC's specialty?

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

Does St Clair Specialty Physicians PC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 23D2100285) is associated with this NPI, valid through August 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does St Clair Specialty Physicians PC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 3 other insurers list St Clair Specialty Physicians PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for St Clair Specialty Physicians PC was last updated on October 17, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.