PROVENA CARE LLC
NPI 1124840962
Clinic/Center - Primary Care in Miami, FL
About Provena Care Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVENA CARE LLC (NPI 1124840962) is a healthcare organization registered as a primary care in Miami, Florida and active in the NPI registry since October 2024. The organization holds a CLIA Waiver certificate valid through January 4, 2028 and lists Hector Fernandez, Administrator, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Provena Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Provena Care LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 10D2336459
Provena Care LLC · Miami, FLFrequently 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 Provena Care LLC's NPI number?
The NPI number for Provena Care LLC is 1124840962. It was assigned to this organization in the NPPES registry on October 31, 2024.
Where is Provena Care LLC located?
Provena Care LLC is located at 10251 SW 72nd St Ste 106, Miami, FL 33173. The listed phone number is (305) 395-7108.
What is Provena Care LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Provena Care LLC enrolled in Medicare?
Yes. Provena Care LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Provena Care LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Provena Care LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Provena Care LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 10D2336459) is associated with this NPI, valid through January 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Provena Care LLC was last updated on October 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 days 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.
# Provena Care Llc · NPI 1124840962
Primary Care organization in Miami, Florida. Organization record, active in the CMS NPPES registry since October 31, 2024.
## Identity
- **NPI:** 1124840962 (Entity type: Organization)
- **Enumerated:** October 31, 2024
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Hector Fernandez, ADMINISTRATOR
## Practice location
- **Address:** 10251 SW 72ND ST STE 106, Miami, FL 33173-2957
- **Phone:** (305) 395-7108 · **Fax:** (786) 883-9691
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 19, 2026
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1124840962) · Data from the CMS NPPES public registry.