Divine Dermatology and Surgical Institute, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC

Practice address

1327 Eagle Dr
Loveland, CO 80537-8059

Phone

(970) 286-2668

NPI assigned

Mar 14, 2020

Last updated

Mar 14, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLCAs reported in NPPES

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

Authorized official

Name

Jennifer Michelle DivineNPI 1063779072

Title

Owner

Phone

(970) 286-2668

Specialties & licenses 1

Addresses

Other names 1

• Divine Dermatology and Surgical Institute Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Divine Dermatology and Surgical Institute PLLC2 organizations share this tax ID, including this one

Part of

Divine Dermatology and Surgical Institute PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Divine Dermatology and Surgical Institute, PLLC

  • Dermatology Physician
  • Longmont, CO
  • NPI 1962164269
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00104

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Divine Dermatology and Surgical Institute, PLLC

  • Medical Specialty Clinic/Center
  • Fort Collins, CO
  • NPI 1215460290
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Michelle Divine, MD

  • MOHS-Micrographic Surgery Physician
  • Fort Collins, CO
  • NPI 1063779072
  Authorized official Same address or phone
• Brooke Ashley Cerkovnik, PA-C

  • Physician Assistant
  • Cody, WY
  • NPI 1881177079

  Dermatology

  NPD (past)

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

{
    "created_epoch": "1584144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584144000000",
    "number": "1104452804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 EAGLE DR",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805378059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 EAGLE DR",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805378059",
            "telephone_number": "970-286-2668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC",
        "enumeration_date": "2020-03-14",
        "last_updated": "2020-03-14",
        "certification_date": "2020-03-14",
        "status": "A",
        "authorized_official_last_name": "DIVINE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-286-2668"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divine Dermatology and Surgical Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• James Dillon, DC, BS
• Noelle Dimas, IBCLC
• Jaimie C Dirks, PMHNP-BC, FNP-C
• Elizabeth Ann Disalvo, M.S., CCC-SLP
• Discover Life PC
• Kimberly Rae Dixon, NP
• Mark Ernest Dixon
• Kyle Doerfler
• Cassandra Doherty
• Kyle Dokken, LMT

• Dermatology Physician in Loveland, CO
• Providers in Loveland, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.