MATTHEW J PROVENZANO M.D.
NPI 1639388911
Otolaryngology - Pediatric Otolaryngology in Michigan City, IN

Q: What is Matthew Provenzano's NPI number?

The NPI number for Matthew Provenzano is 1639388911. It was assigned to this individual provider in the NPPES registry on May 22, 2007.

Q: What is Matthew Provenzano's specialty?

The primary specialty registered for this NPI is Otolaryngology, specializing in Pediatric Otolaryngology, with taxonomy code 207YP0228X.

Active since May 22, 2007PECOS EnrolledAccepts Medicare Assignment

1225 E COOLSPRING AVE STE 300, MICHIGAN CITY, IN 46360(219) 878-5032(219) 861-8151 Get Directions Write a Review

NPPES record last updated: August 24, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 24, 2023, Mar 13, 2021, Apr 22, 2020 and 2 more (5 updates tracked since 2017).

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About Matthew J Provenzano M.d. NPPES

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

MATTHEW J PROVENZANO M.D. (NPI 1639388911) is an individual pediatric otolaryngology provider in Michigan City, Indiana, licensed in Indiana (01072216A) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with Franciscan Health Michigan City, and is a graduate of Johns Hopkins University School Of Medicine (2004).

NPPES Registry Identity

NPI1639388911

Entity TypeIndividualMale

Primary Taxonomy207YP0228X

Provider Legal NameMATTHEW J PROVENZANOCredential: M.D.

Location Address1225 E COOLSPRING AVE STE 300Michigan City, IN 46360-6312

Mailing AddressPo Box 781076Detroit, MI 48278-1076 · (317) 528-4800 · Fax (317) 865-1479

Phone(219) 878-5032

Fax(219) 861-8151

Sole ProprietorNo

Medical School CMSJohns Hopkins University School Of MedicineGraduated 2004

Enumeration DateMay 22, 2007

Last NPPES UpdateAugust 24, 20235 updates tracked since enumeration

NPPES CertifiedAugust 24, 2023

✔ NPI 1639388911 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOtolaryngology · Pediatric OtolaryngologyAllopathic & Osteopathic Physicians

Taxonomy Code207YP0228X

Licenses✔ Licensed in IN · 01072216A✔ Licensed in OH · 57.019215

Definition

A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing.

Also ListedOtolaryngologyTaxonomy 207Y00000X · License 01072216A (IN), 36490 (IA)

1225 E COOLSPRING AVE STE 300, Michigan City, IN 46360

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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 ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Matthew J Provenzano M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5799919874

PECOS Enrollment IDI20131002000632

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 11

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

131 services131 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

113 services100 patients

Diagnostic exam of voice box using a flexible endoscope 31575

This procedure involves a doctor examining your voice box using a flexible endoscope, a thin tube with a light and camera. It's inserted through your nose or mouth to visualize your throat area. It helps detect any abnormalities in your voice box, ensuring optimal vocal health.

112 services107 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

88 services88 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

77 services71 patients

Removal of impacted ear wax 69210

Impacted ear wax removal is a safe procedure to clear blockages in the ear canal caused by hardened ear wax. A healthcare professional uses specialized tools or a gentle irrigation method to loosen and remove the wax, improving hearing and alleviating discomfort.

54 services52 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Franciscan Health Michigan City

Acute Care Hospitals · Michigan City, IN

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number150015

Location3500 Franciscan WayMichigan City, IN 46360 · La Porte County

Emergency services Birthing friendly

Franciscan Health Dyer

Acute Care Hospitals · Dyer, IN

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number150090

Location24 Joliet StDyer, IN 46311 · Lake County

Emergency services Birthing friendly

Franciscan Health Crown Point

Acute Care Hospitals · Crown Point, IN

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number150126

Location12750 Saint Francis DriveCrown Point, IN 46307 · Lake County

Emergency services Birthing friendly

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Other Providers at the Same Location NPPES 6

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

SUZANNE MARIE SMITH MSN, RN, CNS, FNP

Nurse Practitioner (Family)