Robert A Provencher, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB04853900 Issued in NJ

Practice address

296 Kings Highway
Clarksboro, NJ 08020

Phone

(856) 423-7000

NPI assigned

Jul 3, 2006

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 NJ

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

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bayada at Inspira, Home Health and Hospice Home health agency, Millville, NJ, CCN 317089
• Holy Redeemer Home Care NJ South Home health agency, Runnemede, NJ, CCN 317025
• Inspira Medical Center Mullica Hill Hospital, Elmer, NJ, CCN 310069

Merit-based Incentive Payment System (MIPS)

Final score

24.12 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

80.39

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

• Holy Redeemer Home Care, Inc.

  • Home Health Agency
  • Runnemede, NJ
  • NPI 1730153479
  Care Compare affiliation
• Inspira Medical Centers, Inc.

  • General Acute Care Hospital
  • Elmer, NJ
  • NPI 1255396024
  Care Compare affiliation
• Inspira Medical Centers, Inc.

  • General Acute Care Hospital
  • Mullica Hill, NJ
  • NPI 1366097032
  Care Compare affiliation
• South Jersey Hospital, Inc.

  • Physical Therapy Clinic/Center
  • Mullica Hill, NJ
  • NPI 1609158732

  Hospital

  Care Compare affiliation
• Tri-County Home and Hospice Care,LLC

  • Home Health Agency
  • West Deptford, NJ
  • NPI 1629431481
  Care Compare affiliation
• Tri-County Home and Hospice Care,LLC

  • Home Health Agency
  • Millville, NJ
  • NPI 1710340575
  Care Compare affiliation

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1669402152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 KINGS HIGHWAY",
            "city": "CLARKSBORO",
            "state": "NJ",
            "postal_code": "08020",
            "telephone_number": "856-423-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 KINGS HIGHWAY",
            "city": "CLARKSBORO",
            "state": "NJ",
            "postal_code": "08020",
            "telephone_number": "856-423-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "ROBERT",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB04853900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miracle in Progress 3D and 4D Ultra
• Gerald Scott Orlando II, DO
• Brian Otoole
• Mark P Pandolfo, DC
• Crystal Valerie Pizarro, LPC, NCC
• Kaye Rubin
• Ruhe Wellness LLC
• Emily Rose Salema, PSY.D.
• Diana Sophia Tsombaris, D.P.M.

• Family Medicine Physician in Clarksboro, NJ
• Providers in Clarksboro, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; 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.