Divine Medical LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

DIVINE MEDICAL LLC

Practice address

13163 233Rd St # 1
Rosedale, NY 11422-1305

Phone

(718) 525-3347

NPI assigned

Apr 12, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Augustine UmeozorNPI 1326069428

Title

Ceo/Medical Director

Phone

(917) 742-2442

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Augustine Umeozor, M.D.

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1326069428
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1586649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586649600000",
    "number": "1952920795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13163 233RD ST # 1",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114221305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13163 233RD ST # 1",
            "city": "ROSEDALE",
            "state": "NY",
            "postal_code": "114221305",
            "telephone_number": "718-525-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-12",
        "last_updated": "2020-04-12",
        "certification_date": "2020-04-12",
        "status": "A",
        "authorized_official_last_name": "UMEOZOR",
        "authorized_official_first_name": "AUGUSTINE",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "917-742-2442",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02208982",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bernisier Destine, OTR/L
• Cassandre Deus, LMSW
• Tere Hope Dickson, MD, MPH
• Diva Multicare Services Inc.
• Farah Divers
• Divine Neuropsychiatric Services
• Jasmin Doris, OTD, OTR/L
• Marie Dormevil
• Cindly Dorsainvil
• Daniela Dorsainvil

• Primary Care Clinic/Center in Rosedale, NY
• Providers in Rosedale, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.