Divya Bhanu Sree Madisetty, M.D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

99070 Issued in GA

Practice address

Dignity Health, St. Bernardine Medical Center, 2101 N.
San Bernardino, CA 92404

Phone

(909) 644-5892

NPI assigned

May 13, 2021

Reactivated

Oct 12, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

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 2

Specialty

Internal Medicine

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cogent Healthcare of Georgia PCGroup PAC ID 2961483607, 252 clinicians

Sound Physicians of Florida IV, LLCGroup PAC ID 6002198082, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairview Park Hospital Hospital, Dublin, GA, CCN 110125
• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
• Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Cogent Healthcare of Georgia PC

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1609827823
  Medicare reassignment Care Compare group NPD
• Sound Physicians of Florida IV, LLC

  • Internal Medicine Physician
  • Palm Coast, FL
  • NPI 1740633635
  Medicare reassignment Care Compare group
• Fairview Park, Limited Partnership

  • General Acute Care Hospital
  • Dublin, GA
  • NPI 1285688234
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adventhealth Palm Coast Parkway Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1861102345
  Care Compare affiliation
• Fairview Park, Limited Partnership

  • General Acute Care Hospital
  • Dublin, GA
  • NPI 1285688234
  Care Compare affiliation
• Memorial Hospital Flagler Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1093389124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 N. WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92404",
            "telephone_number": "909-644-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DIGNITY HEALTH, ST. BERNARDINE MEDICAL CENTER, 2101 N.",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92404",
            "telephone_number": "909-644-5892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADISETTY",
        "first_name": "DIVYA BHANU SREE",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "deactivation_date": "2022-09-26",
        "reactivation_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "99070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lance Mack
• Rebekah L Mackamul
• Stembile Madakiwe
• Merle Madera, M.D.
• Jocelyn G Madi
• Talesha D. Madison
• Debraanne Madrigal, RN
• Jacqueline Madrigal
• Maf Imaging Center LLC
• Nomagugu Mafu, NP

• Internal Medicine Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.