Jennifer Michelle Divine, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

DR.0058205 Issued in CO

Practice address

1260 Doctor'S Lane
Fort Collins, CO 80524

Phone

(970) 286-2668

Fax

(970) 294-4954

NPI assigned

Apr 15, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Michelle Corbin Former name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

DermatologyAlso: Micrographic Dermatologic Surgery (MDS)

Education

University of South Florida College of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Divine Dermatology and Surgical Institute PLLCGroup PAC ID 0941571236, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

96.67 of 100Reported as individual

Quality

93.33

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Divine Dermatology and Surgical Institute, PLLC

  • Medical Specialty Clinic/Center
  • Fort Collins, CO
  • NPI 1215460290
  Medicare reassignment Care Compare group NPD Authorized official
• Divine Dermatology and Surgical Institute, PLLC

  • Dermatology Physician
  • Longmont, CO
  • NPI 1962164269
  NPD (past) Authorized official
• Mountain Air, LLC

  • Oxygen Equipment & Supplies (DME)
  • Fort Collins, CO
  • NPI 1922332956
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1063779072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 DOCTOR'S LANE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 DOCTOR'S LANE",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80524",
            "telephone_number": "970-286-2668",
            "fax_number": "970-294-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "JENNIFER",
        "middle_name": "MICHELLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-15",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME 131766",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CO",
            "license": "DR.0058205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CORBIN",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Discover Massage, LLC
• Christy M Dittmar, MS ,OTR, CDRS
• Kara Leah Ditullio, PA C
• Amruta Kumudini Divekar
• Divine Dermatology and Surgical Institute, PLLC
• Amanda Dixon, FNP
• Benjamin Dixon, DPT
• Brianne T Dixon, LPC
• Kiara Dixon, LPC
• Joseph Ryan Dobbins, DPT

• MOHS-Micrographic Surgery Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• MOHS-Micrographic Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.