Active NPI
Divya Panneerselvam
- Pediatrics Physician
- Cape Coral, FL
National Provider Identifier
1083026108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME123954
- Practice address
- 316 Del Prado Blvd S
Cape Coral, FL 33990-1710 - Phone
- (239) 226-4592
- Fax
- (239) 458-0623
- NPI assigned
- May 22, 2014
- Last updated
- Jul 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME123954 | FL | Primary |
Addresses
Primary practice location
316 Del Prado Blvd S
Cape Coral, FL 33990-1710
Mailing address
PO Box 1357
Fort Myers, FL 33902-1357
Phone (239) 278-3600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 014953400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230117002784 | CA | Order and Referring Only - Pediatric Medicine | 4587979273 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Mary's Medical Center | Past | Accepting new patients | |
| Upmc Washington | Past | Accepting new patients | |
| Family Health Centers of Southwest Florida Inc | Past | Accepting new patients | |
| Lee Memorial Health System | Past | Accepting new patients |
Interoperability endpoints
- dpanneerselvam@pa.trimed.direct-ci.com
- dpanneerselvam245077@direct-ucsfmedicalcenter.org
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Lehigh Acres, FL
- NPI 1508027848
-
dba Lee Memorial Hospital
- General Acute Care Hospital
- Fort Myers, FL
- NPI 1558302570
-
dba Essentia Health St. Mary's Hospice & Palliative Care
- Community Based Hospice Care Agency
- Duluth, MN
- NPI 1225089634
-
- Rehabilitation Hospital Unit
- Washington, PA
- NPI 1427166602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467676800000",
"number": "1083026108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1357",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339021357",
"telephone_number": "239-278-3600",
"fax_number": "239-278-3857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 DEL PRADO BLVD S",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339901710",
"telephone_number": "239-226-4592",
"fax_number": "239-458-0623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANNEERSELVAM",
"first_name": "DIVYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-22",
"last_updated": "2016-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME123954",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "014953400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.