NPIMap

Individual provider Active NPI

Divya Menon, PA-C

  • Medical Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1255772141
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9107224 Issued in FL
Practice address
1824 King St Ste 300
Jacksonville, FL 32204
Phone
(904) 388-1820
Fax
(904) 388-1827
NPI assigned
Jul 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9107224 FL Primary

Addresses

Primary practice location

1824 King St Ste 300
Jacksonville, FL 32204

Mailing address

1507 S Hiawassee Rd
Ste 107
Orlando, FL 32835-5706
Phone (407) 445-9545

Other practice location 1

251 Maitland Ave Ste 116
Altamonte Springs, FL 32701-4913
Phone (407) 915-5643

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130820001079 FL Practitioner - Physician Assistant 4688817778 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Med-Psych Consultants LLCGroup PAC ID 5799115713, 20 clinicians
Inpatient Care Specialists LLCGroup PAC ID 0345493623, 101 clinicians
Orlando Inpatient Medicine PAGroup PAC ID 0749598316, 54 clinicians

Practice addresses (Care Compare)

1507 S Hiawassee Rd
Suite 206
Orlando, FL 32835-5719
Phone 4074459545222

525 Technology Park
Suite 109
Lake Mary, FL 32746-7107
Phone 4076472346111

601 E Rollins St
Orlando, FL 32803-1248
Phone (407) 445-9545

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9107224FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Feb 1, 2018 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 27, 2016 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 27, 2016 Accepting new patients
Fairbanks Partners LLC CurrentSince Nov 4, 2017 Accepting new patients
Adventhealth Orlando Cardiac & Vascular Specialists LLC PastSince Aug 10, 2025 Accepting new patients

Locations

1699 S 14th St
Ste 9
Fernandina Beach, FL 32034
Phone (904) 206-5000

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

1824 King St
Ste 300
Jacksonville, FL 32204
Phone (904) 381-9393

400 Celebration Pl
Kissimmee, FL 34747
Phone (407) 303-4000

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

265 E Rollins St
Ste 12000
Orlando, FL 32804

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1255772141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 S HIAWASSEE RD",
            "address_2": "STE 107",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328355706",
            "telephone_number": "407-445-9545",
            "fax_number": "407-445-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 KING ST STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-388-1820",
            "fax_number": "904-388-1827"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "251 Maitland Ave Ste 116",
            "address_purpose": "LOCATION",
            "city": "Altamonte Springs",
            "state": "FL",
            "postal_code": "327014913",
            "country_code": "US",
            "telephone_number": "407-915-5643",
            "fax_number": "407-960-2602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENON",
        "first_name": "DIVYA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-09",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.