NPIMap

Individual provider Active NPI

Alan Divine, M.D.

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1104825280
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
26378 Issued in 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
Last updated
Nov 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 26378 MN Primary

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 3

IdentifierTypeStateIssuer
0401146OtherMNMEDICA
HP19647OtherMNHEALTH PARTNERS
876265100MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address adivine84172@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040220000593 MN Practitioner - Internal Medicine 9032004734 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 SystemGroup PAC ID 4587573613, shared by 87 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26378MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Aug 26, 2013 Accepting new patients
Allina Health System CurrentSince Aug 26, 2013 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

920 E 28th St
Ste 300
Minneapolis, MN 55407
Phone (612) 863-3900

920 E 28th St
Ste 460
Minneapolis, MN 55407
Phone (612) 863-7501

920 E 28th St
Ste 560
Minneapolis, MN 55407
Phone (612) 863-3770

920 E 28th St
Ste 610
Minneapolis, MN 55407
Phone (612) 863-6900

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

  • Direct secure messaging: adivine84172@excellian.direct.allina.com

Organizations & group practices 5

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.

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1104825280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 S 8TH ST",
            "address_2": "PARKSIDE PROFESSIONAL BLDG., STE 600",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041208",
            "telephone_number": "612-339-7171",
            "fax_number": "612-339-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 S 8TH ST",
            "address_2": "PARKSIDE PROFESSIONAL BLDG., STE 600",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041208",
            "telephone_number": "612-339-7171",
            "fax_number": "612-339-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "26378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0401146",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP19647",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876265100",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adivine84172@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "2855 Campus Dr Ste 400",
            "city": "Plymouth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554412659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.