Steven Marc Divack, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

143879 Issued in NY

Practice address

115 Eastern Pkwy
Brooklyn, NY 11238-6085

Phone

(718) 638-8484

Fax

(718) 638-8588

NPI assigned

Sep 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

New York Medical College, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Healthcare IncGroup PAC ID 1254233158, 58 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: steven.divack.p1@direct.premierhealthcare.nextgenshare.com

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.

• Premier Healthcare, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
  • NPI 1760436190
  Medicare reassignment Care Compare group NPD
• Steven M Divack, M.D., P.C.

  • Ophthalmology Physician
  • Brooklyn, NY
  • NPI 1881962223
  Medicare reassignment NPD Authorized official
• Premier Healthcare, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
  • NPI 1831330182
  NPD

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306939723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 EASTERN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112386085",
            "telephone_number": "718-638-8484",
            "fax_number": "718-638-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 EASTERN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112386085",
            "telephone_number": "718-638-8484",
            "fax_number": "718-638-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVACK",
        "first_name": "STEVEN",
        "middle_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "143879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00523744",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ditmas Park Wellness PT PLLC
• Ditmas Pharmacy Corp
• Dinean Ann Ditolla, MS,CCC-SLP
• Oksana Ditwell, AGNP
• Jillian Leigh Diuguid-Gerber, MD
• Tina Marie Divello
• Marshall Andrew Diven, MD, MS
• Diverse Minds Corp
• Diverse Minds Corp
• Diverse NP in Family Adult Health and Gerontology, PLLC

• Ophthalmology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.