MARK PHILLIP PROVENZANO M.D. - NPI 1811094584 - Orthopaedic Surgery in Houston, TX

Q: What is Mark Provenzano's NPI number?

The NPI number for Mark Provenzano is 1811094584. It was assigned to this individual provider in the NPPES registry on September 17, 2006.

Q: What is Mark Provenzano's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery, specializing in Sports Medicine, with taxonomy code 207XX0005X.

Q: When was this NPI record last updated?

The NPPES record for Mark Provenzano was last updated on March 4, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Mark Phillip Provenzano M.d. NPPES

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

MARK PHILLIP PROVENZANO M.D. (NPI 1811094584) is an individual sports medicine provider in Houston, Texas, licensed in Texas (G3705) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS and is a graduate of Baylor College Of Medicine (1982).

NPPES Registry Identity

NPI1811094584

Entity TypeIndividualMale

Primary Taxonomy207XX0005X

Provider Legal NameMARK PHILLIP PROVENZANOCredential: M.D.

Location Address950 CAMPBELL RDHouston, TX 77024-2804

Mailing Address950 Campbell RdHouston, TX 77024-2804 · (713) 464-0077 · Fax (713) 464-9582

Phone(713) 464-0077

Fax(713) 464-9582

Sole ProprietorNo

Medical School CMSBaylor College Of MedicineGraduated 1982

Enumeration DateSeptember 17, 2006

Last NPPES UpdateMarch 4, 2026

NPPES CertifiedMarch 4, 2026

✔ NPI 1811094584 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic Surgery · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207XX0005X

License✔ Licensed in TX · G3705

Definition

An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries.

950 CAMPBELL RD, Houston, TX 77024

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Other Identifiers 2

OtherMDG3705TX · License Number

Other0025EPTX · Bcbs Provider #

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mark Phillip Provenzano M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4284786773

PECOS Enrollment IDI20090714000531

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.

Other Providers at the Same Location NPPES 9

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

WENDY ALEXANDER

Specialist/Technologist, Other (Orthopedic Assistant)