Divine Pearl Home Health

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

DIVINE PEARL HOME HEALTH

Practice address

121 N State College Blvd Ste 12a
Anaheim, CA 92806-2929

Phone

(714) 603-7415

Fax

(714) 603-7439

NPI assigned

May 26, 2021

Last updated

Feb 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rolando Dy Buco

Title

Administrator

Phone

(714) 603-7415

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154996676. Details of each certification follow.

• CCN 757422 Home health agency · Active · Details

Home health agency certification: CCN 757422

Legal name

DIVINE PEARL HOME HEALTH

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Oct 24, 2023

Last certification

Jan 4, 2023

Organization structure

CorporationProprietary

Incorporated

Apr 1, 2021 in CA

Enrollment address

121 N State College Blvd
Ste 12a
Anaheim, CA 92806-2929

Listed as

Divine Pearl Home HealthCCN 757422 · All quality measures

Overall star rating

3.5 of 5

Ownership

-

Certified

Oct 24, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Locations

Interoperability endpoints

• Direct secure messaging: admin@divinepearlhomehealth.com
• Direct secure messaging: admin@stjudehospicecare.com

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Dennis L Clark, MD

  • Internal Medicine Physician
  • Long Beach, CA
  • NPI 1699700849

  Home health agency

  Care Compare affiliation
• John D Homan, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Huntington Beach, CA
  • NPI 1437116142

  Home health agency

  Care Compare affiliation
• Peter Hugh, D.O.

  • Family Medicine Physician
  • Lakewood, CA
  • NPI 1316035082

  Home health agency

  Care Compare affiliation
• Laura Carolina Nieves, MD

  • Internal Medicine Physician
  • Corona, CA
  • NPI 1073808994

  Home health agency

  Care Compare affiliation
• Eric Mario Tate, M.D.

  • Internal Medicine Physician
  • Paramount, CA
  • NPI 1790869139

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1154996676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N STATE COLLEGE BLVD STE 12A",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062929",
            "telephone_number": "714-603-7415",
            "fax_number": "714-603-7439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N STATE COLLEGE BLVD STE 12A",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062929",
            "telephone_number": "714-603-7415",
            "fax_number": "714-603-7439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE PEARL HOME HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "DY BUCO",
        "authorized_official_first_name": "ROLANDO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-603-7415",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@stjudehospicecare.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "121 N State College Blvd Ste 1A",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928062926",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@divinepearlhomehealth.com",
            "affiliation": "N",
            "endpointDescription": "Company official Email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "121 N State College Blvd Ste 12A",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928062929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Direct Diagnostics Inc.
• Direct Diagnostics Inc.
• Evan Disciullo
• Catherine Dito, MD
• Diversified Counseling Services, Inc.
• Alexis Dixon
• Leah Dixon
• Sheri Ann Dixon, LCSW
• Bianka Diza
• Anne Grace Enriquez Dizon

• Home Health Agency in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; 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.
• 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.