OrganizationActive
St Clair Specialty Physicians
NPI 1063719292 · Nephrology Physician · Boise, ID
Provider details
- NPI number
- 1063719292
- Entity type
- Organization
- Primary specialty
- Nephrology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Robert Provenzano, President/Partner(313) 886-8787
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
5610 Gage Street
Suite a
Boise, ID 83706
Phone: (208) 367-3370
Street-level locationGet directions
Mailing address
45640 Schoenherr Road
Shelby Twp, MI 48315
Registry dates
- Enumerated
- 2011-02-24
- Last updated
- 2011-02-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.