Augie N. Provencio

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A48099 Issued in CA

Practice address

600 B St BLDG a-C
Livingston, CA 95334-9593

Phone

(209) 850-3500

NPI assigned

Feb 2, 2007

Last updated

Mar 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Dr. Augustine Quinones Provencio Professional name

Medicare fee-for-service enrollment

Enrolled in CA

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

Family PracticeAlso: Emergency Medicine

Education

New York Medical College, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Timothy S Johnston MD PCGroup PAC ID 1456638238, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Home Care Home health agency, Merced, CA, CCN 557523

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: augustine.provenciomd.p3@direct.livingstoncommunity.nextgenshare.com

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

• Timothy S. Johnston, M.D. PC

  • Family Medicine Physician
  • Merced, CA
  • NPI 1407306665
  Medicare reassignment Care Compare group
• Big River Emergency Physicians Inc

  • Emergency Medicine Physician
  • Hollister, CA
  • NPI 1033501168
  Medicare reassignment NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment NPD
• Lumira Healthcare

  dba Livingston Campus Center

  • Federally Qualified Health Center (FQHC)
  • Livingston, CA
  • NPI 1427110329
  Medicare reassignment NPD
• San Joaquin Emergency Medical Associates

  • Emergency Medicine Physician
  • Merced, CA
  • NPI 1588960413
  Medicare reassignment NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Turlock, CA
  • NPI 1932686367
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Lumira Healthcare

  dba Modesto Florida Ave Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1649099151
  NPD
• Lumira Healthcare

  dba Delhi Health Center

  • Federally Qualified Health Center (FQHC)
  • Delhi, CA
  • NPI 1730530254
  NPD
• Timothy S. Johnston, M.D. PC

  dba Sunshine Pediatrics

  • Primary Care Clinic/Center
  • Merced, CA
  • NPI 1427793371
  NPD
• Dignity Health

  dba Mercy Medical Center Merced

  • General Acute Care Hospital
  • Merced, CA
  • NPI 1518018191
  NPD (past)
• Lumira Healthcare

  dba LCH Pharmacy

  • Community/Retail Pharmacy
  • Livingston, CA
  • NPI 1073175675
  NPD (past)

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

• Dignity Health

  dba Mercy Home Care

  • Home Health Agency
  • Merced, CA
  • NPI 1235289117
  Care Compare affiliation

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1467590158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 B ST BLDG A-C",
            "city": "LIVINGSTON",
            "state": "CA",
            "postal_code": "953349593",
            "telephone_number": "209-850-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 B ST BLDG A-C",
            "city": "LIVINGSTON",
            "state": "CA",
            "postal_code": "953349593",
            "telephone_number": "209-850-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Whiteriver",
            "state": "AZ",
            "postal_code": "85941",
            "country_code": "US",
            "telephone_number": "928-338-4911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVENCIO",
        "first_name": "AUGIE",
        "middle_name": "N.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "36333",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "3673",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A48099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A480990",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "539497",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUGUSTINE",
            "last_name": "PROVENCIO",
            "middle_name": "QUINONES",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Junabel Mariano Pedro
• Monica Guadalupe Perez
• Connie Phan, B.S.
• Vincent Lamarr Powell Jr., FNP
• Ivan M Prado
• Jade Rose Puckett
• Afnan Aisha Qadeer, M.D.
• Maria D Ramirez, EMT
• Miguel Ramirez, EMT-B
• Ran Health Services, Inc.

• Family Medicine Physician in Livingston, CA
• Providers in Livingston, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.