Mauro Provencio, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

P1809 Issued in TX

Practice address

12810 Edgemere Blvd
El Paso, TX 79938-4532

Phone

(915) 504-6955

Fax

(915) 504-6954

NPI assigned

Jun 6, 2008

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

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

Family PracticeAlso: Sports Medicine

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sun City Sports Medicine and Family Clinic, PA

  • Sports Medicine (Family Medicine) Physician
  • El Paso, TX
  • NPI 1114289956
  Medicare reassignment NPD Authorized official
• North East Family Clinic PA

  • Family Medicine Physician
  • El Paso, TX
  • NPI 1255849097
  Medicare reassignment NPD

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1952560682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12810 EDGEMERE BLVD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799384532",
            "telephone_number": "915-504-6955",
            "fax_number": "915-504-6954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12810 EDGEMERE BLVD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799384532",
            "telephone_number": "915-504-6955",
            "fax_number": "915-504-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCIO",
        "first_name": "MAURO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P1809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Alan Protzman, M.D.
• Provedoras Caseras de El Paso Inc.
• Proveedoras de Luz Home Health, LLC
• Provencio Enterprises Incorporated
• Provencio Enterprises Incorporated
• Tracy Lynn Provenghi, DDS
• Providence Imaging Consultants, P.a.
• Providence Service Corporation
• Provident Eye Specialists, PA
• Jessica Estelle Provine

• Family Medicine Physician in El Paso, TX
• Providers in El Paso, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.