NPIMap

Individual provider Active NPI

Jonathan Divine, D.O.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1710173968
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS 10858 Issued in FL
Practice address
3059 Edgewood Ave W
Jacksonville, FL 32209-2207
Phone
(904) 647-3180
NPI assigned
Sep 21, 2007
Last updated
Oct 8, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS 10858 FL Primary

Addresses

Primary practice location

3059 Edgewood Ave W
Jacksonville, FL 32209-2207

Mailing address

3059 Edgewood Ave W
Jacksonville, FL 32209-2207
Phone (904) 647-3180

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
I20101006001053 FL Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 9133311368 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
West Virginia School of Osteopathic Medicine, 2007
Medicare assignment
May accept Medicare assignment
Group practices
St Vincent's Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

1801 Barrs St
Suite 120
Jacksonville, FL 32204-4738
Phone (904) 308-2006

9504 Crosshill Blvd
Suite 108
Jacksonville, FL 32222-5851
Phone (904) 308-7792

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS 10858FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Aug 1, 2025 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jul 1, 2014 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jul 1, 2014 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC CurrentSince Aug 1, 2025 Accepting new patients
Dedicated Senior Medical Center of Florida, LLC Current Accepting new patients

Locations

3059 Edgewood Ave W
Jacksonville, FL 32209
Phone (904) 647-3180

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

4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

Organizations & group practices 6

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 5

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": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1710173968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3059 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322092207",
            "telephone_number": "904-647-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3059 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322092207",
            "telephone_number": "904-647-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "JONATHAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-21",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS 10858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.