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

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: October 18, 2026.

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, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignment

Medicare enrollment records show Stephen Provonsha reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
Same address
Health Maintenance Organization
10800 MAGNOLIA AVE
Riverside, CA 92505
  • Reassigned Medicare billing, California enrollment
  • 5,228 clinicians in this Medicare group
NPI 1316979834 (866) 984-7483

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

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

KAISER PERMANENTE
General Acute Care Hospital
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (951) 353-4988
PATRICK T MC GILL PA
Physician Assistant
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000
ROBERT L. RUDEK MD
Surgery
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000
RICHARD M. BRADBURNE MD
Internal Medicine (Critical Care Medicine)
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000
SUNG JIN JOHN MD
Family Medicine
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000
SHELLY C. THIO MD
Internal Medicine
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000
GREGORY MARRUJO MD
Thoracic Surgery (Cardiothoracic Vascular Surgery)
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000
REBECCA J SEAWELL NP
Nurse Practitioner
10800 MAGNOLIA AVE
RIVERSIDE, CA 92505
Riverside County (909) 353-2000

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 Stephen Provonsha's NPI number?

The NPI number for Stephen Provonsha is 1598836413. It was assigned to this individual provider in the NPPES registry on November 13, 2006.

Where is Stephen Provonsha located?

Stephen Provonsha practices at 10800 Magnolia Ave, Riverside, CA 92505. The listed phone number is (909) 353-2000.

What is Stephen Provonsha's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Stephen Provonsha enrolled in Medicare?

Yes. Stephen Provonsha is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Stephen Provonsha's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Stephen Provonsha reassigns Medicare benefits to Southern California Permanente Medical Group (Riverside, CA). The 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 Stephen Provonsha's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Stephen Provonsha was last updated on November 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.