Johanna Caroline Provencher, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT40856 Issued in FL

Practice address

1040 Gulf Breeze Pkwy Ste 200
Gulf Breeze, FL 32561-7808

Phone

(850) 916-3700

NPI assigned

Jun 11, 2020

Last updated

Jan 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, FL2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Mercy College, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Florida Surgeons PAGroup PAC ID 2769381391, 336 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.79 of 100Reported as group

Quality

64.42

Promoting interoperability

100

Improvement activities

40

Cost

74.88

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: johanna.provencher.1@9109.direct.athenahealth.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.

• North Florida Surgeons, PA

  • Surgery Physician
  • Jacksonville, FL
  • NPI 1912953290
  Medicare reassignment Care Compare group NPD
• Benchmark Physical Therapy of North Carolina LLC

  • Physical Therapist
  • Ooltewah, TN
  • NPI 1356894604

  NC

  Medicare reassignment NPD
• Revolution Incorporated

  • Physical Therapist
  • Fayetteville, NC
  • NPI 1164921862
  Medicare reassignment NPD
• North Florida Surgeons, PA

  dba NFS Florida Bone and Joint

  • Orthopaedic Surgery Physician
  • Gulf Breeze, FL
  • NPI 1871442053
  NPD
• Benchmark Physical Therapy of NC, LLC

  • Physical Therapist
  • Leland, NC
  • NPI 1588189112
  NPD
• Breakthrough Physical Therapy

  • Physical Therapist
  • Morehead City, NC
  • NPI 1083937692
  NPD (past)

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1508481938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11945 SAN JOSE BLVD STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322231627",
            "telephone_number": "904-396-1725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 GULF BREEZE PKWY STE 200",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325617808",
            "telephone_number": "850-916-3700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1040 Gulf Breeze Pkwy Ste 207",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "325617808",
            "country_code": "US",
            "telephone_number": "850-916-3700",
            "fax_number": "850-916-3710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4012 N 9th Ave # Pod3",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325032824",
            "country_code": "US",
            "telephone_number": "850-807-4200",
            "fax_number": "850-916-8499",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1040 Gulf Breeze Pkwy Ste 209",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "325617808",
            "country_code": "US",
            "telephone_number": "850-916-3700",
            "fax_number": "850-916-3710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4406 N Davis Hwy",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325032756",
            "country_code": "US",
            "telephone_number": "850-435-4800",
            "fax_number": "850-807-5209",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5660 Gulf Breeze Pkwy Ste A-1",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "325639599",
            "country_code": "US",
            "telephone_number": "850-916-3700",
            "fax_number": "850-916-3726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "JOHANNA",
        "middle_name": "CAROLINE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT40856",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P19565",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primary Care House Calls PA
• Alexandra Lauren Pritchett, FNP-C
• Chandler Fulton Pritchett, DDS
• Proactive Physical Therapy of Florida LLC
• Proper Dermatology PLLC
• Psgfl MSSP, LLC
• PT Solutions of Pensacola, LLC
• Publix Super Markets Inc (Publix Pharmacy #1189)
• Publix Super Markets Inc
• Pvha/Sims - Gulf Breeze Courtyard, LLC

• Physical Therapist in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.