OrganizationActive
Provo Kidney Care LLC
NPI 1972056893 · Nephrology Physician · Waltham, MA
Provider details
- NPI number
- 1972056893
- Entity type
- Organization
- Primary specialty
- Nephrology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Pamela Vp, Vice President(480) 639-7186
- License
- 001 (UT)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 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
920 Winter St
Waltham, MA 02451-1521
Phone: (480) 639-7186
Fax: (602) 798-8267
Approximate (ZIP-level) locationGet directions
Mailing address
920 Winter St
Waltham, MA 02451-1521
Registry dates
- Enumerated
- 2016-07-27
- Last updated
- 2016-07-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.