Kathleen Ann Divincenzo, M.D.
Individual provider Active NPI Internal Medicine Physician · Cody, WY
NPI 1477596989 · NPPES record last updated Oct 5, 2020
Key facts
- NPI
- 1477596989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 4494A (WY)
- Practice address
- 707 Sheridan Ave
Cody, WY 82414 - Phone
- (307) 578-2480
- Fax
- (307) 578-2492
- NPI assigned
- Jun 13, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.79 of 100
- Quality
- 72.82
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 63.14
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050210000363 | WY | Practitioner - Hospitalist |
3375525835 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4494A | WY | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cody Regional Health EMS | Current |
Accepting new patients | |
| West Park Hospital District Long Term Care Center | Past | Accepting new patients |
Locations
707 Sheridan Ave
Cody, WY 82414
Phone (307) 527-7561
424 Yellowstone Ave
Ste 120
Cody, WY 82414
Phone (307) 578-2903
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4494A | WY | Yes |
Addresses
Primary practice location
707 Sheridan Ave
Cody, WY 82414
Mailing address
707 Sheridan Ave
Cody, WY 82414
Phone (307) 578-2480
Other providers in Cody, WY
- Derrik Walton DDS & Darren J. Ruesch DDS, PC
- Jacob G Despain
- Misty A Di Meglio
- Chelsea Dillahunty
- Leyla Dim
- Joshua Dobson
- Stephen Ward Dominick
- Marchand Dondero
- Katie Marie Donham
- Kevin S. Dougherty
All providers in Cody, WY · Internal Medicine Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.