Amanda Bustamante Provencio, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

RS2018-0570 Issued in NM

Practice address

1240 S Telshor Blvd Ste a
Las Cruces, NM 88011-4731

Phone

(575) 259-3638

Fax

(855) 538-0781

NPI assigned

Jun 21, 2018

Last updated

Aug 25, 2025By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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 Practice

Education

University of New Mexico School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

PHC-Las Cruces IncGroup PAC ID 4486635802, 22 clinicians

Northwest Hospital Medicine Physicians LLCGroup PAC ID 6406805449, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Las Cruces, NM, CCN 320018
• Artesia General Hospital Hospital, Artesia, NM, CCN 320030
• Mountain View Regional Medical Center Hospital, Las Cruces, NM, CCN 320085
• Rehabilitation Hospital of Southern New Mexico,Inc Inpatient rehabilitation facility, Las Cruces, NM, CCN 323032
• Artesia Healthcare & Rehabilitation Center, LLC Nursing home, Artesia, NM, CCN 325128

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amanda.provencio.1@19849.direct.athenahealth.com
• FHIR API: https://fhir4.healow.com/fhir/r4/DEIIDD
• FHIR API: https://fhir4.healow.com/fhir/r4/DEIIDD/Endpoint/DEIIDD

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.

• Healthy You Personalized Primary Care

  • Family Medicine Physician
  • Las Cruces, NM
  • NPI 1780473785
  Medicare reassignment NPD Authorized official
• Northwest Hospital Medicine Physicians LLC

  • Hospitalist Physician
  • Las Cruces, NM
  • NPI 1972056752
  Medicare reassignment Care Compare group NPD
• PHC-Las Cruces Inc

  • Family Medicine Physician
  • Las Cruces, NM
  • NPI 1164445136
  Medicare reassignment Care Compare group NPD
• New Mexico Pac Services PC

  • Hospitalist Physician
  • Santa Fe, NM
  • NPI 1801325634
  Medicare reassignment NPD
• NM Pacs 2 LLC

  • Hospitalist Physician
  • Albuquerque, NM
  • NPI 1366928749
  Medicare reassignment NPD
• CS Pacs 3 West LLC

  • Hospitalist Physician
  • Sunnyvale, CA
  • NPI 1073378238

  NM

  Medicare reassignment NPD
• PHC Las Cruces Inc

  dba ID Consultants

  • Infectious Disease Physician
  • Las Cruces, NM
  • NPI 1942581202
  NPD
• Artesia Healthcare & Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Artesia, NM
  • NPI 1770113722
  NPD (past)
• PHC-Las Cruces Inc

  dba Memorial Medical Center of Las Cruces

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1700821808
  NPD (past)
• Rehabilitation Hospital of Southern New Mexico, Inc

  • Rehabilitation Hospital
  • Las Cruces, NM
  • NPI 1679578066
  NPD (past)

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

• Artesia General Hospital

  • General Acute Care Hospital
  • Artesia, NM
  • NPI 1437286044
  Care Compare affiliation
• Artesia Healthcare & Rehabilitation Center LLC

  • Skilled Nursing Facility
  • Artesia, NM
  • NPI 1770113722

  Nursing home

  Care Compare affiliation
• Las Cruces Medical Center LLC

  dba Mountainview Regional Medical Center

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1205882503
  Care Compare affiliation
• PHC-Las Cruces Inc

  dba Memorial Medical Center of Las Cruces

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1700821808
  Care Compare affiliation
• Rehabilitation Hospital of Southern New Mexico, Inc

  • Rehabilitation Hospital
  • Las Cruces, NM
  • NPI 1679578066

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1558855650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 S TELSHOR BLVD STE A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114731",
            "telephone_number": "575-259-3638",
            "fax_number": "855-538-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 S TELSHOR BLVD STE A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114731",
            "telephone_number": "575-259-3638",
            "fax_number": "855-538-0781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCIO",
        "first_name": "AMANDA",
        "middle_name": "BUSTAMANTE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-21",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "RS2018-0570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Progressive Residential Services of New Mexico, Inc.
• Project Fernando, LLC
• David Protextor
• Devonna Protextor
• Maria Protextor
• Jeanne Provencio, LPCC
• Teddey Provencio
• Rita Alyssa Prudencio
• Amanda Pryor, DNP
• Yadira Puente

• Family Medicine Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; 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.