Marc Provenzano

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1119122 Issued in TX

Practice address

493 N Main St
Groveton, TX 75845-2498

Phone

(281) 515-8349

NPI assigned

Sep 22, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hospitalist Medicine Physicians of Texas PLLCGroup PAC ID 3476688318, 685 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI St Lukes Health Memorial Livingston Hospital, Livingston, TX, CCN 450395

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Hospitalist Medicine Physicians of Texas, PLLC

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1629307095
  Medicare reassignment Care Compare group NPD

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

• Memorial Hospital of Polk County

  dba CHI St. Luke's Heath Memorial Livingston

  • Rural Acute Care Hospital
  • Livingston, TX
  • NPI 1689650616
  Care Compare affiliation

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

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1285413922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 395",
            "city": "GROVETON",
            "state": "TX",
            "postal_code": "758450395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 N MAIN ST",
            "city": "GROVETON",
            "state": "TX",
            "postal_code": "758452498",
            "telephone_number": "281-515-8349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "MARC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-22",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1119122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Nicole Johnson, RN
• Keith Edward Jones, PA-C
• Lone Star Expeditions, Inc.
• Francis Dawn McElreath, CPHT
• Melanie L Parker, FNP
• Jasmine Reyna
• Heather Spangler-Curry, BEHAVIOR TECHNICIAN
• Nancy O'Quinn Thomas, RPH
• Trinity Memorial Hospital District (Avir at Groveton)
• Patricia Moore Wars, LPC

• Acute Care Nurse Practitioner in Groveton, TX
• Providers in Groveton, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.