LISA PROVENZANO (N.P.) – Nurse Practitioner, NPI 1609051135
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,106 NURSE PRACTITIONER in MI
Provider Addresses for LISA PROVENZANO (N.P.)
799 DENISON CT
STE B
BLOOMFIELD HILLS, MI 483020053
Phone: (248) 751-7246
Fax: (248) 418-2311
Type: Mailing
359 ENTERPRISE CT SPC B
BLOOMFIELD HILLS, MI 483021055
Phone: (248) 751-7246
Fax: (248) 418-2311
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 40 Open Payments records for all available years, with a total value of $804.
Total Amount is formed as General ($804) + Research ($0) + Ownership ($0) = $804.
Last reported payment date: 2024-10-31 • Largest payer in this snapshot: ABBVIE INC. ($269).
Total Amount
$804
General + Research + Ownership
Payments
40
Total payment records
General Amount
$804
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-31
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $269 |
| Collegium Pharmaceutical, Inc. | $176 |
| Medtronic, Inc. | $114 |
| Nalu Medical, Inc. | $55 |
| Pacira Pharmaceuticals Incorporated | $38 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-09-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040916000187 | I | Nurse Practitioner | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 48302)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Interventional Pain Management, Anesthesiology | MI | |
| A N E S T H E S I O L O G Y | MI | |
| A N E S T H E S I O L O G Y | MI | |
| Anesthesiology, Pain Management | MI | |
| A N E S T H E S I O L O G Y | MI | |
| A N E S T H E S I O L O G Y | MI | |
| Nurse Practitioner | MI | |
| A N E S T H E S I O L O G Y | MI | |
| A N E S T H E S I O L O G Y | MI | |
| Certified Registered Nurse Anesthetist (Crna) | CA |
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