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

Last updated

May 31, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Lara Kathleen Johnson Former name

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Titusville Area HospitalGroup PAC ID 8022907575, 77 clinicians

Titusville Area Health Services, Inc.Group PAC ID 3173505997, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Titusville Area Health Services, Inc.

  • Family Medicine Physician
  • Titusville, PA
  • NPI 1639189889
  Medicare reassignment Care Compare group NPD
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Oil City, PA
  • NPI 1760976336
  Medicare reassignment Care Compare group NPD
• Butler Medical Providers

  • Gastroenterology Physician
  • Butler, PA
  • NPI 1619493046
  Medicare reassignment
• Butler Medical Providers

  • Rural Health Clinic/Center
  • Fairmount City, PA
  • NPI 1386253854
  NPD
• Oil Valley Internal Medicine Associates PC

  • Internal Medicine Physician
  • Titusville, PA
  • NPI 1598871550
  NPD
• Titusville Area Hospital

  • Audiologist
  • Titusville, PA
  • NPI 1306712104
  NPD
• Titusville Area Hospital

  • Rural Health Clinic/Center
  • Tionesta, PA
  • NPI 1326509837
  NPD (past)

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

• Titusville Area Hospital

  • Critical Access Hospital
  • Titusville, PA
  • NPI 1891899332
  Care Compare affiliation

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

{
    "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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• Forest Area School District
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• Suzi Hartzell, LPC
• Kerry Isovitsch, LPN
• John R Slagle (Tionesta Pharmacy)

• Physician Assistant in Tionesta, PA
• Providers in Tionesta, PA by specialty
• 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.