NPI age
15 years
Enumerated 2011-02-24
● Active Type 2 · Organization
St Clair Specialty Physicians
St Clair Specialty Physicians is 1 of 46 internal medicine organizations in Idaho.
Primary specialty
Internal Medicine
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Provenzano
President/partner
Last NPPES update
2011-02-24
Source: monthly bulk 2026-05
How this organization compares
Across 46 active internal medicine providers in Idaho.
NPI age
15 years
↓ 4 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2011 → 2026
2011-02Enumerated in NPPES
2011
2026
Where they practice
Primary practice location
5610 Gage Street, Suite A
Boise, ID 83706
Mailing address
45640 Schoenherr Road
Shelby Twp, MI 48315
Authorized official
Robert Provenzano, MD
President/partner
📞 3138868787
Specialties
-
Internal Medicine PrimaryAn 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.
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.