Casey Ryan Divin

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP135899 Issued in TX

Practice address

5414 Fredericksburg Rd Ste 100a
San Antonio, TX 78229-3641

Phone

(210) 468-0800

NPI assigned

Nov 21, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• TH of San Antonio, LLC

  • Community Based Hospice Care Agency
  • San Antonio, TX
  • NPI 1326353095

  W-2 Managing Employee

  CMS ownership

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.

• Vpa of Texas PLLC

  • Family Medicine Physician
  • Irving, TX
  • NPI 1679510499
  Medicare reassignment NPD
• Vpa of Texas PLLC

  • Clinical Social Worker
  • San Antonio, TX
  • NPI 1578175865
  NPD
• San Antonio Functional Health PLLC

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1407621964
  NPD (past)

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

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1154835536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20529 WIND SPGS",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782587457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5414 FREDERICKSBURG RD STE 100A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293641",
            "telephone_number": "210-468-0800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20529 Wind Spgs",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782587457",
            "country_code": "US",
            "telephone_number": "210-677-9697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIVIN",
        "first_name": "CASEY",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-21",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP135899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Ann Dittrich
• Diverse Speech Therapy Solutions, LLC
• Diverse Speech Therapy Solutions, LLC
• Diversicare Normandy Terrace LLC
• Diversity Holdings LLC
• Divine Youth Guidance LLC
• Erica Divine, LPC
• Divinity Caregivers LLC
• Divinity Hospice
• Lisa M Dix Emperador, M.D.

• Family Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.