Divino Avellanosa

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1650 Issued in AR

Practice address

109 Briarcliff Rd
Branson, MO 65616-3735

Phone

(417) 339-4069

NPI assigned

Mar 22, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stein Ancillary Services, LLCGroup PAC ID 1153374046, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Stein Ancillary Services, LLC

  • Rehabilitation Practitioner
  • Fort Smith, AR
  • NPI 1073591582

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Mount Carmel Physical Therapy Center, PLLC

  • Physical Therapist
  • Harrison, AR
  • NPI 1912339771
  Medicare reassignment

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458604800000",
    "number": "1851753651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 BRIARCLIFF RD",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656163735",
            "telephone_number": "417-339-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 BRIARCLIFF RD",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656163735",
            "telephone_number": "417-339-4069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVELLANOSA",
        "first_name": "DIVINO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT1650",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra L Ashley, MD
• Deloris Elaine Ashlock-Ruda, FNP
• Connie Celicia Atchison, DNP
• Atlas Home Health and Therapy LLC
• Anna Marie Bautista Avellanosa, PT
• Amber Michelle Babb, FNP-C
• Melissa M Bacon
• Pamela M Bacon, DMD
• David Badami, MD
• Jackson Philip Bagby, DO

• Physical Therapist in Branson, MO
• Providers in Branson, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.