Mark Phillip Provenzano, M.D.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

G3705 Issued in TX

Practice address

950 Campbell Rd
Houston, TX 77024-2804

Phone

(713) 464-0077

Fax

(713) 464-9582

NPI assigned

Sep 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Baylor College of Medicine, 1982

Medicare assignment

May accept Medicare assignment

Group practices

Mark Provenzano MD PAGroup PAC ID 1557413044, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Mark Provenzano MD PA

  • Specialist
  • Houston, TX
  • NPI 1720261456
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1811094584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 CAMPBELL RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770242804",
            "telephone_number": "713-464-0077",
            "fax_number": "713-464-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 CAMPBELL RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770242804",
            "telephone_number": "713-464-0077",
            "fax_number": "713-464-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "MARK",
        "middle_name": "PHILLIP",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "TX",
            "license": "G3705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "MDG3705",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "0025EP",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica B Proud, MD
• Provectus Medicorum Surgical Assist, LLC
• Proven Care Pharmacy LLC
• Sarah Elizabeth Provence, PHARMD
• Kathleen Provencher, N.P
• Providence Assisted Living Home, Inc.
• Providence Chiropractic Clinic LLC
• Providence Clearlake Specialty Hospital LLC
• Providence EMS LLC
• Providence ER of Clearlake, PLLC

• Sports Medicine (Orthopaedic Surgery) Physician in Houston, TX
• Providers in Houston, TX by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; 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.