ST. CLAIR NEPHROLOGY, IDAHO NEPHROLOGY ASSOCIATES
NPI 1154361616
Internal Medicine - Nephrology in Roseville, MI
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
Specialties & Licenses 2
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
St. Clair Nephrology, Idaho Nephrology Associates is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date 2
Next revalidation due by December 31, 2026
This provider holds 2 Medicare enrollments with upcoming revalidation dates. Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
36Medicare enrollment records show 36 clinicians reassign Medicare billing to St. Clair Nephrology, Idaho Nephrology Associates, which bills Medicare for the services they deliver. Of these, 8 practice at this address and 14 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 3
Nearest to this location (20)
See all 36Detroit, MI 48236
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, MIFrequently 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.
Is St Clair Specialty Physicians PC enrolled in Medicare?
Yes. St Clair Specialty Physicians PC is registered in the Medicare PECOS enrollment system.
When is St Clair Specialty Physicians PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), St Clair Specialty Physicians PC holds 2 Medicare enrollments with upcoming revalidation dates. The next is due by December 31, 2026 (Non-DME Part B, Oregon, Clinic/Group Practice). Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through St Clair Specialty Physicians PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 36 clinicians in 3 Medicare specialties reassign their Medicare billing to St Clair Specialty Physicians PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nephrology (19), Nurse Practitioner (16) and Internal Medicine (1). Of these, 8 practice at this address and 14 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 4 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 4 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.
# St. Clair Nephrology, Idaho Nephrology Associates · NPI 1154361616
Nephrology organization in Roseville, Michigan. Organization record, active in the CMS NPPES registry since June 6, 2006.
## Identity
- **NPI:** 1154361616 (Entity type: Organization)
- **Enumerated:** June 6, 2006
- **Primary specialty:** Internal Medicine - Nephrology · taxonomy 207RN0300X
- **Legal business name:** St Clair Specialty Physicians Pc
- **Organization subpart:** No
- **Authorized official:** Christopher Provenzano, CEO/MANAGING EMPLOYEE (W2)
## Practice location
- **Address:** 18001 E 10 MILE RD, SUITE 1, Roseville, MI 48066-3803
- **Phone:** (586) 218-5800 · **Fax:** (586) 532-6496
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Oregon, Clinic/Group Practice), next of 2 enrollments with upcoming dates · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 36 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nephrology (19), Nurse Practitioner (16), Internal Medicine (1); 8 practice at this address and 14 within 10 miles; [full list](https://npiprofile.com/npi/1154361616/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 17, 2022
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1154361616) · Data from the CMS NPPES public registry.