Lara Kathleen Divins

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

111 Bridge St
Tionesta, PA 16353-9737

Phone

(814) 755-3631

Fax

(814) 755-3633

NPI assigned

May 2, 2012

Sex

Female

Sole proprietor

Yes

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.

• Titusville Area Health Services, Inc.

  • Family Medicine Physician
  • Titusville, PA
  • NPI 1639189889

  PA

  Medicare reassignment Care Compare group NPD
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Oil City, PA
  • NPI 1760976336

  PA

  Medicare reassignment Care Compare group NPD
• Butler Medical Providers

  • Gastroenterology Physician
  • Butler, PA
  • NPI 1619493046

  PA

  Medicare reassignment
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Tionesta, PA
  • NPI 1326509837
  Care Compare group NPD (past)
• Titusville Area Hospital

  • Emergency Medicine Physician
  • Titusville, PA
  • NPI 1013012335
  Care Compare group
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Conneaut Lake, PA
  • NPI 1053873976
  Care Compare group
• Titusville Area Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Titusville, PA
  • NPI 1104921428
  Care Compare group
• Titusville Area Hospital

  • Anatomic Pathology & Clinical Pathology Physician
  • Titusville, PA
  • NPI 1164149811
  Care Compare group
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Conneautville, PA
  • NPI 1235691973
  Care Compare group
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Titusville, PA
  • NPI 1316471212
  Care Compare group
• Titusville Area Hospital

  • Diagnostic Radiology Physician
  • Titusville, PA
  • NPI 1366992315
  Care Compare group
• Titusville Area Hospital

  • Cardiovascular Disease Physician
  • Titusville, PA
  • NPI 1598869141
  Care Compare group

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

• Titusville Area Hospital

  • Critical Access Hospital
  • Titusville, PA
  • NPI 1891899332

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Titusville Area Hospital 77 clinicians

Titusville Area Health Services, Inc. 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Titusville Area Hospital Hospital, Titusville, PA, CCN 391314

Medicare fee-for-service enrollment

Enrolled in PA

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

Credentials

Physician Assistant

Practice roles

Locations

• Lara Kathleen Johnson Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 31, 2021.

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622419200000",
    "number": "1174881775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 W OAK ST",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "163541404",
            "telephone_number": "814-755-3631",
            "fax_number": "814-755-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BRIDGE ST",
            "city": "TIONESTA",
            "state": "PA",
            "postal_code": "163539737",
            "telephone_number": "814-755-3631",
            "fax_number": "814-755-3633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 N Monroe St",
            "address_purpose": "LOCATION",
            "city": "Titusville",
            "state": "PA",
            "postal_code": "163541113",
            "country_code": "US",
            "telephone_number": "814-758-7676",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Main St",
            "address_purpose": "LOCATION",
            "city": "Tidioute",
            "state": "PA",
            "postal_code": "163511062",
            "country_code": "US",
            "telephone_number": "814-484-3096",
            "fax_number": "814-484-3097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "116 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Oil City",
            "state": "PA",
            "postal_code": "163012736",
            "country_code": "US",
            "telephone_number": "814-676-0431",
            "fax_number": "814-677-6343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIVINS",
        "first_name": "LARA",
        "middle_name": "KATHLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-02",
        "last_updated": "2021-05-31",
        "certification_date": "2021-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARA",
            "last_name": "JOHNSON",
            "middle_name": "KATHLEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Tionesta, PA
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.