Divine Dermatology and Surgical Institute, PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

DR.0058205 Issued in CO

Legal business name

DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC

Practice address

1260 Doctors LN
Fort Collins, CO 80524-4038

Phone

(813) 765-8453

NPI assigned

Apr 6, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Divine, M.D.NPI 1063779072

Title

Owner

Phone

(970) 388-2850

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Divine Dermatology and Surgical Institute, PLLC

  • Dermatology Physician
  • Loveland, CO
  • NPI 1104452804
  NPPES parent name

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Michelle Divine, MD

  • MOHS-Micrographic Surgery Physician
  • Fort Collins, CO
  • NPI 1063779072
  Medicare reassignment Care Compare group NPD Authorized official
• Lauren Garlock

  • Medical Physician Assistant
  • Fort Collins, CO
  • NPI 1205655487
  Medicare reassignment Care Compare group
• Erika Leigh Guider, PA-C

  • Physician Assistant
  • Loveland, CO
  • NPI 1558638189
  Medicare reassignment Care Compare group
• Joshua Hickman, PA-C

  • Medical Physician Assistant
  • Fort Collins, CO
  • NPI 1326512781
  Medicare reassignment Care Compare group
• Hannah Pierce, PA-C

  • Medical Physician Assistant
  • Longmont, CO
  • NPI 1053024570
  Medicare reassignment Care Compare group
• Natalie Darlene Miller, PA-C

  • Medical Physician Assistant
  • Fort Collins, CO
  • NPI 1235578477
  Medicare reassignment
• Samantha Skelton

  • Advanced Practice Midwife
  • Fort Collins, CO
  • NPI 1619422094
  NPD (past)
• Corey Snyder, CNM

  • Advanced Practice Midwife
  • Shawnee Mission, KS
  • NPI 1992040273
  NPD (past)

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1215460290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 DOCTORS LN STE A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244072",
            "telephone_number": "970-286-2668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 DOCTORS LN",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244038",
            "telephone_number": "813-765-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-06",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "DIVINE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-388-2850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CO",
            "license": "DR.0058205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Disabled Resource Services
• Discover Massage, LLC
• Christy M Dittmar, MS ,OTR, CDRS
• Kara Leah Ditullio, PA C
• Amruta Kumudini Divekar
• Jennifer Michelle Divine, MD
• Amanda Dixon, FNP
• Benjamin Dixon, DPT
• Brianne T Dixon, LPC
• Kiara Dixon, LPC

• Medical Specialty Clinic/Center in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Medical Specialty Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.