Active NPI
Todd Lee Divan, DPM
- Foot & Ankle Surgery Podiatrist
- Union City, TN
National Provider Identifier
1235201898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 734
- Practice address
- 1415 E Reelfoot Ave
Union City, TN 38261-5812 - Phone
- (731) 885-0220
- Fax
- (731) 885-0216
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | 016-004761 | IL | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 734 | TN | Primary |
Addresses
Primary practice location
1415 E Reelfoot Ave
Union City, TN 38261-5812
Mailing address
1415 E Reelfoot Ave
Union City, TN 38261-5812
Phone (731) 885-0220
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016-004-761 | Medicaid | IL | |
| 480019679 | Other | IL | PALMETTO - MEDICARE |
| 09206992 | Other | IL | BCBS INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016-004761 | IL | MD | Foot Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367452800000",
"number": "1235201898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1415 E REELFOOT AVE",
"city": "UNION CITY",
"state": "TN",
"postal_code": "382615812",
"telephone_number": "731-885-0220",
"fax_number": "731-885-0216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 E REELFOOT AVE",
"city": "UNION CITY",
"state": "TN",
"postal_code": "382615812",
"telephone_number": "731-885-0220",
"fax_number": "731-885-0216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIVAN",
"first_name": "TODD",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2013-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "IL",
"license": "016-004761",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "TN",
"license": "734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "016-004-761",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO - MEDICARE",
"identifier": "480019679",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INSURANCE",
"identifier": "09206992",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Union City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.