John M Provenza, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

017860 Issued in LA

Practice address

8383 Millicent Way Ste B
Shreveport, LA 71115

Phone

(318) 631-9121

Fax

(318) 213-6246

NPI assigned

Oct 27, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Gastroenterology

Education

Louisiana State University School of Medicine in Shreveport, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gi Specialists Hospitalists at WKMCGroup PAC ID 6002060001, 12 clinicians

Gastrointestinal Specialists AMCGroup PAC ID 0547245086, 32 clinicians

Capitol City Family Health Center IncorporatedGroup PAC ID 5193639151, 41 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
• Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mark.provenza@gis.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Capitol City Family Health Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1265548614
  Medicare reassignment Care Compare group NPD
• Gastrointestinal Specialists, a.M.C.

  • Gastroenterology Physician
  • Shreveport, LA
  • NPI 1932171725
  Medicare reassignment Care Compare group NPD
• Gi Specialists Hospitalists at WKMC

  • Gastroenterology Physician
  • Shreveport, LA
  • NPI 1255676870
  Medicare reassignment Care Compare group NPD
• Christus Health Northern Louisiana

  • Certified Registered Nurse Anesthetist
  • Shreveport, LA
  • NPI 1801822762
  Medicare reassignment NPD
• Proprium Solutions LLC

  • Pharmacy
  • Shreveport, LA
  • NPI 1508636986
  NPD Authorized official
• Capitol City Family Health Center, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1720965767
  NPD
• Winn Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Winnfield, LA
  • NPI 1275769119
  NPD
• Winn Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ruston, LA
  • NPI 1447133459
  NPD
• Winn Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Colfax, LA
  • NPI 1740601418
  NPD
• Shreveport Endoscopy Center, a Medical Corporation

  • Endoscopy Clinic/Center
  • Shreveport, LA
  • NPI 1982676771
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Christus Health Northern Louisiana

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1417950106
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1225028434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 MABEL ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034022",
            "telephone_number": "318-631-9121",
            "fax_number": "318-631-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8383 MILLICENT WAY STE B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71115",
            "telephone_number": "318-631-9121",
            "fax_number": "318-213-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZA",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "LA",
            "license": "017860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MD.017860",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376442",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Promise Hospital of Louisiana, Inc
• Promoting Livelihood and Ability in Youth Physical Therapy LLC
• Promyse-Prosthetic Orthotic Group
• Proprium Solutions LLC
• Kaitlin Prosinski, MOT, OTR/L
• Stephanie Maria Provenzano
• Provider Care Inc.
• Leslie Lewynell Provost
• Elizabeth Pruitt, M.ED
• Evelyn Baranco Pryor, MD

• Gastroenterology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Gastroenterology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.