1. Home
  2. Directory
  3. Texas
  4. El Paso
  5. Family Medicine
  6. NPI Profile

SUN CITY SPORTS MEDICINE AND FAMILY CLINIC, PA
NPI 1114289956
Family Medicine - Sports Medicine in El Paso, TX

Active since June 07, 2012CLIA 45D2047058 · Waiver
12810 EDGEMERE BLVD, EL PASO, TX 79938(915) 504-6955(915) 504-6954 Get Directions Write a Review

NPPES record last updated: June 18, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 18, 2024, May 8, 2024 (2 updates tracked since 2024).

About Sun City Sports Medicine And Family Clinic, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUN CITY SPORTS MEDICINE AND FAMILY CLINIC, PA (NPI 1114289956) is a healthcare organization registered as a sports medicine in El Paso, Texas and active in the NPI registry since June 2012. The organization holds a CLIA Waiver certificate valid through September 17, 2026 and lists Mauro Provencio, Md/owner, as its authorized official.

NPPES Registry Identity

NPI1114289956
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameSUN CITY SPORTS MEDICINE AND FAMILY CLINIC, PA
Location Address12810 EDGEMERE BLVDEl Paso, TX 79938-4532
Mailing Address12810 Edgemere BlvdEl Paso, TX 79938-4532 · (915) 222-8747
Phone(915) 504-6955
Fax(915) 504-6954
Organization SubpartNo
Authorized OfficialMauro ProvencioMd/owner · (915) 525-3209
Enumeration DateJune 7, 2012
Last NPPES UpdateJune 18, 20242 updates tracked since enumeration
NPPES CertifiedJune 18, 2024
✔ NPI 1114289956 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
License✔ Licensed in TX · P1809
Definition
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
12810 EDGEMERE BLVD, El Paso, TX 79938
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2047058

Sun City Sports Medicine And Family Clinic,pa · El Paso, TX
Active · expires Sep 17, 2026
CLIA Number45D2047058
Laboratory TypePhysician Office
Certificate Effective DateSeptember 18, 2024
Certificate Expiration DateSeptember 17, 2026
Laboratory DirectorMauro Provencio
Laboratory Phone(915) 504-6955
Laboratory LocationSun City Sports Medicine And Family Clinic,pa12810 Edgemere Blvd, El Paso, TX 79938
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SONIA VILLEZCAS FNP-C
Nurse Practitioner (Family)
12810 EDGEMERE BLVD
EL PASO, TX 79938
Hudspeth County (915) 504-6955
MARZIEH WEBB FNP-C
Nurse Practitioner (Family)
12810 EDGEMERE BLVD
EL PASO, TX 79938
Hudspeth County (915) 504-6955
DR. MAURO PROVENCIO M.D.
Family Medicine
12810 EDGEMERE BLVD
EL PASO, TX 79938
Hudspeth County (915) 504-6955

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sun City Sports Medicine And Family Clinic, PA's NPI number?

The NPI number for Sun City Sports Medicine And Family Clinic, PA is 1114289956. It was assigned to this organization in the NPPES registry on June 7, 2012.

Where is Sun City Sports Medicine And Family Clinic, PA located?

Sun City Sports Medicine And Family Clinic, PA is located at 12810 Edgemere Blvd, El Paso, TX 79938. The listed phone number is (915) 504-6955.

What is Sun City Sports Medicine And Family Clinic, PA's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Does Sun City Sports Medicine And Family Clinic, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2047058) is associated with this NPI, valid through September 17, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Sun City Sports Medicine And Family Clinic, PA accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Sun City Sports Medicine And Family Clinic, PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sun City Sports Medicine And Family Clinic, PA was last updated on June 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.