A & S DIVINE HEALTHCARE SERVICES PLLC
NPI 1215519038
Nurse Practitioner - Family in Calumet City, IL
About A & S Divine Healthcare Services Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
A & S DIVINE HEALTHCARE SERVICES PLLC (NPI 1215519038) is a healthcare organization registered as a family in Calumet City, Illinois and active in the NPI registry since April 2021. The organization holds a CLIA Waiver certificate valid through April 27, 2027 and lists Angel White, Co-owner/family Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
A & S Divine Healthcare Services Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to A & S Divine Healthcare Services PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 14D2222293
A & S Divine Healthcare · Calumet City, ILFrequently 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 A & S Divine Healthcare Services PLLC's NPI number?
The NPI number for A & S Divine Healthcare Services PLLC is 1215519038. It was assigned to this organization in the NPPES registry on April 21, 2021.
Where is A & S Divine Healthcare Services PLLC located?
A & S Divine Healthcare Services PLLC is located at 1477 Ring Rd, Calumet City, IL 60409. The listed phone number is (708) 933-6346.
What is A & S Divine Healthcare Services PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is A & S Divine Healthcare Services PLLC enrolled in Medicare?
Yes. A & S Divine Healthcare Services PLLC is registered in the Medicare PECOS enrollment system.
When is A & S Divine Healthcare Services PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Illinois, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through A & S Divine Healthcare Services PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to A & S Divine Healthcare Services 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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does A & S Divine Healthcare Services PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D2222293) is associated with this NPI, valid through April 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for A & S Divine Healthcare Services PLLC was last updated on November 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# A & S Divine Healthcare Services Pllc · NPI 1215519038
Family organization in Calumet City, Illinois. Organization record, active in the CMS NPPES registry since April 21, 2021.
## Identity
- **NPI:** 1215519038 (Entity type: Organization)
- **Enumerated:** April 21, 2021
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Angel White, CO-OWNER/FAMILY NURSE PRACTITIONER
## Practice location
- **Address:** 1477 RING RD, Calumet City, IL 60409-5459
- **Phone:** (708) 933-6346 · **Fax:** (708) 933-6356
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Illinois, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 16, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1215519038) · Data from the CMS NPPES public registry.