STEPHEN G. PROVONSHA MD
NPI 1598836413
General Practice in Riverside, CA

Q: What is the provider's specialty?

The provider's specialty is General Practice with taxonomy code 208D00000X.

Active since November 13, 2006PECOS Enrolled

10800 MAGNOLIA AVE, RIVERSIDE, CA 92505(909) 353-2000 Get Directions Write a Review

NPPES record last updated: November 30, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Stephen G. Provonsha Md NPPES

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

STEPHEN G. PROVONSHA MD (NPI 1598836413) is an individual general practice provider in Riverside, California, licensed in California (G51217) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1598836413

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameSTEPHEN G. PROVONSHACredential: MD

Location Address10800 MAGNOLIA AVERiverside, CA 92505-3043

Mailing Address10800 Magnolia AveRiverside, CA 92505-3043 · (909) 353-2000

Phone(909) 353-2000

Sole ProprietorNo

Enumeration DateNovember 13, 2006

Last NPPES UpdateNovember 30, 2021

✔ NPI 1598836413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in CA · G51217

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

10800 MAGNOLIA AVE, Riverside, CA 92505

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stephen G. Provonsha Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.