DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC
NPI 1215460290
Clinic/Center - Medical Specialty in Fort Collins, CO
About Divine Dermatology And Surgical Institute, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DIVINE DERMATOLOGY AND SURGICAL INSTITUTE, PLLC (NPI 1215460290) is a healthcare organization registered as a medical specialty in Fort Collins, Colorado and active in the NPI registry since April 2017. The organization lists Jennifer Divine, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Divine Dermatology And Surgical Institute, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Divine Dermatology And Surgical Institute, PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Divine Dermatology And Surgical Institute, PLLC's NPI number?
The NPI number for Divine Dermatology And Surgical Institute, PLLC is 1215460290. It was assigned to this organization in the NPPES registry on April 6, 2017.
Where is Divine Dermatology And Surgical Institute, PLLC located?
Divine Dermatology And Surgical Institute, PLLC is located at 1260 Doctors Ln, Fort Collins, CO 80524. The listed phone number is (813) 765-8453.
What is Divine Dermatology And Surgical Institute, PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.
Is Divine Dermatology And Surgical Institute, PLLC enrolled in Medicare?
Yes. Divine Dermatology And Surgical Institute, PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Divine Dermatology And Surgical Institute, PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Divine Dermatology And Surgical Institute, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Divine Dermatology And Surgical Institute, PLLC was last updated on September 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Divine Dermatology And Surgical Institute, Pllc · NPI 1215460290
Medical Specialty organization in Fort Collins, Colorado. Organization record, active in the CMS NPPES registry since April 6, 2017.
## Identity
- **NPI:** 1215460290 (Entity type: Organization)
- **Enumerated:** April 6, 2017
- **Primary specialty:** Clinic/Center - Medical Specialty · taxonomy 261QM2500X
- **Organization subpart:** No
- **Authorized official:** Jennifer Divine, OWNER
## Practice location
- **Address:** 1260 DOCTORS LN, Fort Collins, CO 80524-4038
- **Phone:** (813) 765-8453
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Dermatology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 10, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1215460290) · Data from the CMS NPPES public registry.