Active NPI
Divine Davis
- Community Health Worker
- Bronx, NY
National Provider Identifier
1629542121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 350 E 143Rd St Apt 5B
Bronx, NY 10454-1244 - Phone
- (646) 303-0863
- NPI assigned
- Jan 17, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary | ||
| Community Health Worker | 172V00000X | NY |
Addresses
Primary practice location
350 E 143Rd St Apt 5B
Bronx, NY 10454-1244
Mailing address
350 E 143Rd St Apt 5B
Bronx, NY 10454-1244
Phone (646) 303-0863
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547683200000",
"number": "1629542121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 E 143RD ST APT 5B",
"city": "BRONX",
"state": "NY",
"postal_code": "104541244",
"telephone_number": "646-303-0863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 E 143RD ST APT 5B",
"city": "BRONX",
"state": "NY",
"postal_code": "104541244",
"telephone_number": "646-303-0863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DIVINE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-17",
"last_updated": "2019-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.