Dr David E Provencher Jr, MD is a medicare enrolled "Allergy & Immunology" physician in Plant City, Florida. His current practice location is
106 Southern Oak Drive, Plant City, Florida. You can reach out to his office (for appointments etc.) via phone at
(813) 752-8595.
Dr David E Provencher Jr is licensed to practice in Florida (license number ME81615) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1326098120.
Physician's Profile
| Full Name | Dr David E Provencher Jr |
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| Gender | Male |
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| Speciality | Allergy & Immunology |
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| Location | 106 Southern Oak Drive, Plant City, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1326098120
- Provider Enumeration Date: 05/11/2006
- Last Update Date: 01/16/2020
Medicare PECOS Information:
- PECOS PAC ID: 7719880608
- Enrollment ID: I20040128001097
Medical Identifiers
Medical identifiers for Dr David E Provencher Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1326098120 | NPI | - | NPPES |
| 262145201 | Medicaid | FL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2080P0201X | Pediatrics - Pediatric Allergy/immunology | ME81615 (Florida) | Secondary |
| 207K00000X | Allergy & Immunology | ME81615 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr David E Provencher Jr allows following entities to bill medicare on his behalf.
| Entity Name | Plant City Allergy Pa |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083760748
PECOS PAC ID: 1658267612
Enrollment ID: O20040225001183 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr David E Provencher Jr is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr David E Provencher Jr, MD
Po Box 2156,
Plant City, FL 33564-2156
Ph: (813) 486-2085 | Dr David E Provencher Jr, MD
106 Southern Oak Drive,
Plant City, FL 33563
Ph: (813) 752-8595 |
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