Deactivated NPI 1124113998 Deactivated / Inactive NPI Male Practitioner

Stephen C Provenza , PA

Physician Assistant • Columbus, IN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Stephen Provenza has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 04, 2006

NPI Deactivation Date August 29, 2022

Total Practice Duration ~16 Years of Practice (2006 – 2022)

Professional Overview & Biography Verified Profile Summary

Stephen Provenza, PA was a registered Physician Assistant practicing in Columbus, IN. Throughout an active medical career spanning 16 years, Stephen Provenza provided care at the practice location at 2502 25TH ST until profile deactivation on 2022-08-29.

Historical Medicare Part B clinical services included injection, triamcinolone acetonide, preservative free, 1 mg, testing for presence of drug, by chemistry analyzers, drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

2502 25th St

Columbus, IN 472013728

Telephone 8123728883

Fax 8123728964

Associated Practice Facility / Clinic

🏢 Columbus Urgent Care Center Facility NPI 1548338635

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Columbus, IN

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 6.7 Yrs

State Avg: 9.4 Yrs

Regional Practice Density

31 Specialists

Practicing in Columbus, IN (2429 Statewide)

Telehealth Adoption Rate

6.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

58.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2022)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3300 Injection, triamcinolone acetonide, preservative free, 1 mg	3,040	30	$4.00	$3.80
80307 Testing for presence of drug, by chemistry analyzers	281	75	$150.00	$61.03
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms	269	73	$150.00	$112.23
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	248	78	$125.00	$101.53
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	52	24	$10.00	$6.65
20552 Injections of trigger points in 1 or 2 muscles	30	25	$95.00	$40.57
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	30	25	$300.00	$46.12
82962 Blood glucose (sugar) test performed by hand-held instrument	23	16	$10.00	$3.26
27096 Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance	22	20	$500.00	$186.83
72170 X-ray of pelvis, 1-2 views	12	12	$60.00	$22.16

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3300 Injection, triamcinolone acetonide, preservative free, 1 mg	7,540	44	$4.00	$3.84
Q4177 Floweramnioflo, 0.1 cc	1,341	43	$360.00	$186.03
80307 Testing for presence of drug, by chemistry analyzers	648	81	$150.00	$61.97
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms	643	78	$150.00	$114.09
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	544	84	$125.00	$103.48
27096 Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance	64	36	$500.00	$150.50
20552 Injections of trigger points in 1 or 2 muscles	56	28	$95.00	$43.24
82962 Blood glucose (sugar) test performed by hand-held instrument	53	23	$10.00	$3.28
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	50	28	$300.00	$46.45
36415 Insertion of needle into vein for collection of blood sample	47	16	$215.00	$3.00
64494 Injection of lower or sacral spine facet joint using imaging guidance, second level	44	25	$1000.00	$91.02
64493 Injection of lower or sacral spine facet joint using imaging guidance, single level	44	25	$1100.00	$176.78
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	32	17	$175.00	$84.89
72110 X-ray of lower and sacral spine, minimum of 4 views	30	30	$250.00	$40.02
72170 X-ray of pelvis, 1-2 views	29	29	$60.00	$21.87
73562 X-ray of knee, 3 views	13	12	$120.00	$51.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3300 Injection, triamcinolone acetonide, preservative free, 1 mg	21,260	107	$4.00	$3.82
Q4177 Floweramnioflo, 0.1 cc	840	26	$360.00	$190.80
80307 Testing for presence of drug, by chemistry analyzers	816	142	$150.00	$61.47
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms	775	135	$150.00	$113.31
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	557	129	$125.00	$87.58
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	184	125	$55.00	$35.91
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	136	72	$300.00	$46.25
27096 Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance	121	58	$500.00	$172.74
20552 Injections of trigger points in 1 or 2 muscles	119	65	$95.00	$44.66
82962 Blood glucose (sugar) test performed by hand-held instrument	108	37	$10.00	$3.26
36415 Insertion of needle into vein for collection of blood sample	40	19	$215.00	$2.98
99213 Established patient office or other outpatient visit, typically 15 minutes	32	19	$95.00	$60.29
G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms	32	32	$250.00	$235.94
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	30	16	$175.00	$84.41
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	29	29	$125.00	$83.70
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	26	18	$35.00	$18.41
72170 X-ray of pelvis, 1-2 views	26	26	$60.00	$22.33
64495 Injection of lower or sacral spine facet joint using imaging guidance, third and any additional level	23	11	$1000.00	$95.46
64494 Injection of lower or sacral spine facet joint using imaging guidance, second level	23	11	$1000.00	$95.46
64493 Injection of lower or sacral spine facet joint using imaging guidance, single level	23	11	$1100.00	$185.35
72110 X-ray of lower and sacral spine, minimum of 4 views	22	22	$250.00	$38.15
99201 New patient office or other outpatient visit, typically 10 minutes	17	17	$75.00	$36.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3300 Injection, triamcinolone acetonide, preservative free, 1 mg	3,000	37	$4.00	$3.79
80307 Testing for presence of drug, by chemistry analyzers	116	84	$150.00	$63.36
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms	90	66	$150.00	$112.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	81	72	$125.00	$88.10
G0483 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms	26	26	$250.00	$241.98
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$125.00	$86.96
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	22	21	$300.00	$46.27
20552 Injections of trigger points in 1 or 2 muscles	19	18	$95.00	$44.62
72110 X-ray of lower and sacral spine, minimum of 4 views	18	18	$250.00	$40.75
72170 X-ray of pelvis, 1-2 views	16	16	$60.00	$26.24
82962 Blood glucose (sugar) test performed by hand-held instrument	12	12	$10.00	$3.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	213	91	$73.81	$55.76
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	75	55	$97.47	$73.66
99306 Initial nursing facility visit, typically 45 minutes per day	53	53	$178.27	$134.98
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	53	19	$73.81	$55.76
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	24	15	$97.47	$73.66
99310 Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	23	23	$145.04	$109.66
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	16	15	$47.51	$35.91
99310 Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	15	14	$145.04	$109.66

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License IN 10001076A

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

12 Associated Practitioners

Dr. Richard Miethke , MD

Preventive Medicine - Preventive Medicine/Occupational Environmental Medicine

NPI 1033287149

Doctor of Medicine (M.D.)

Dr. Michelle Cline , DNP, FNP-C

Nurse Practitioner - Family

NPI 1134561269

Doctor of Nursing Practice, Family Nurse Practitioner (Certified)

Kelly Anderson , APRN

Nurse Practitioner - Family

NPI 1184255408

Advanced Practice Registered Nurse

Jennifer Swank , NP

Nurse Practitioner

NPI 1497736425

Nurse Practitioner

Dr. Julie Simpson , DNP, RN

Nurse Practitioner - Family

NPI 1598282774

Doctor of Nursing Practice, Registered Nurse

Jennifer Robinson , NP

Nurse Practitioner - Family

NPI 1598431595

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events

⚠️

NPI Profile Deactivated August 29, 2022

Record deactivated on August 29, 2022

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Updated Practice Location March 08, 2019

Registered at 745 N SWOPE ST, GREENFIELD, IN 46140 (Tel: 3174629221)

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Updated Business Mailing Address March 08, 2019

Registered at 2741 W LAYTON AVE STE 106, MILWAUKEE, WI 532212600 (Tel: 4142425468)

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NPI Profile Active May 12, 2015

NPI status registered as active in NPPES database

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Updated Practice Location May 12, 2015

Registered at 2502 25TH ST, COLUMBUS, IN 472013728 (Tel: 8123728883)

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Updated Business Mailing Address May 12, 2015

Registered at 2502 25TH ST, COLUMBUS, IN 472013728 (Tel: 8123728883)

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Provider Name / Credentials Updated May 12, 2015

Recorded as STEPHEN PROVENZA, PA

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 12, 2015

Physician Assistant (License #10001076A in IN)

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Initial NPI Registration & Enumeration October 04, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1124113998

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 04, 2006

Last Update: May 12, 2015

Deactivation Date: August 29, 2022

Update or Correct Profile

Mailing Address

2502 25th St

Columbus, IN 472013728

Phone: 8123728883

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.