| Augie N Provencio, | |
|
600 B St Bldg A-c, Livingston, CA 95334-9593 | |
| (209) 850-3500 | |
| Not Available |
| Full Name | Augie N Provencio |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 38 Years |
| Location | 600 B St Bldg A-c, Livingston, California |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467590158 | NPI | - | NPPES |
| 00A480990 | Medicaid | CA | |
| 539497 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36333 (Arizona) | Secondary |
| 207Q00000X | Family Medicine | 3673 (Alaska) | Secondary |
| 207Q00000X | Family Medicine | A48099 (California) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Timothy S Johnston Md Pc | 1456638238 | 7 |
| Entity Name | Cep America - California |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023063542 PECOS PAC ID: 6103739131 Enrollment ID: O20031106000520 |
| Entity Name | Oakdale Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598862054 PECOS PAC ID: 4587567490 Enrollment ID: O20040216000564 |
| Entity Name | Livingston Community Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427110329 PECOS PAC ID: 8820084692 Enrollment ID: O20040426000617 |
| Entity Name | San Joaquin Emergency Medical Associates |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1588960413 PECOS PAC ID: 6305022047 Enrollment ID: O20110516000103 |
| Entity Name | Big River Emergency Physicians Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033501168 PECOS PAC ID: 2466764303 Enrollment ID: O20150706002430 |
| Entity Name | Timothy S Johnston Md Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407306665 PECOS PAC ID: 1456638238 Enrollment ID: O20170503002455 |
| Mailing Address | Practice Location Address |
|---|---|
| Augie N Provencio, 600 B St Bldg A-c, Livingston, CA 95334-9593 Ph: (209) 850-3500 | Augie N Provencio, 600 B St Bldg A-c, Livingston, CA 95334-9593 Ph: (209) 850-3500 |
Dr. Afnan Aisha Qadeer, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1140 Main St, Livingston, CA 95334 Phone: 209-394-7913 Fax: 209-394-3660 | |
Mr. Ganesan Venkatapathy, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1140 Main St, Livingston, CA 95334 Phone: 209-394-1362 Fax: 209-394-1369 | |
Karen Marie Romero, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1140 Main St, Livingston, CA 95334 Phone: 209-394-7913 Fax: 209-394-3021 | |
Glen Villanueva, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 600 B St, Livingston, CA 95334 Phone: 209-850-3500 Fax: 209-850-3499 |