Alan Divine, M.D.
Individual provider Active NPI Internal Medicine Physician · Minneapolis, MN
NPI 1104825280 · NPPES record last updated Nov 10, 2020
Key facts
- NPI
- 1104825280
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 26378 (MN)
- Practice address
- 825 S 8TH St
Parkside Professional BLDG., Ste 600
Minneapolis, MN 55404-1208 - Phone
- (612) 339-7171
- Fax
- (612) 339-2885
- NPI assigned
- Jul 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 41
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Minnesota Medical School, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Allina Health System
Practice addresses (Care Compare)
440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225
Hospital & facility affiliations
- Allina Health Home Health
- Accentcare Fairview Home Health - West, LLC
- Centerwell Home Health
- Home Health Care Inc
- Lifespark Home Health
- Abbott Northwestern Hospital
- Mercy Hospital
- M Health Fairview University of MN Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040220000593 | MN | Practitioner - Internal Medicine | 9032004734 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Past | Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
920 E 28th St
Ste 300
Minneapolis, MN 55407
Phone (612) 863-3900
920 E 28th St
Ste 560
Minneapolis, MN 55407
Phone (612) 863-3770
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
920 E 28th St
Ste 610
Minneapolis, MN 55407
Phone (612) 863-6900
550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
920 E 28th St
Ste 460
Minneapolis, MN 55407
Phone (612) 863-7501
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
2855 Campus Dr
Ste 400
Plymouth, MN 55441
Phone (612) 577-7400
2550 University Ave W
Ste 180S
Saint Paul, MN 55114
Phone (651) 635-9173
Interoperability endpoints
- adivine84172@excellian.direct.allina.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 26378 | MN | Yes |
Addresses
Primary practice location
825 S 8TH St
Parkside Professional BLDG., Ste 600
Minneapolis, MN 55404-1208
Mailing address
825 S 8TH St
Parkside Professional BLDG., Ste 600
Minneapolis, MN 55404-1208
Phone (612) 339-7171
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0401146 | Other | MN | MEDICA |
| 876265100 | Medicaid | MN | |
| HP19647 | Other | MN | HEALTH PARTNERS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | adivine84172@excellian.direct.allina.com | Direct |
Other providers in Minneapolis, MN
- Diverse Home Health Care
- Diverse Mental Health Response LLC
- Diversified Home Care Inc
- Diversity Union Group Home Limited Liability Company
- Carmen N Divertie
- Renee Divine
- Division of Indian Work
- Division of Indian Work
- Alexis Aliyah Dixon
- Brian John Dixon
All providers in Minneapolis, MN · Internal Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.