Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DIVINE DERMATOLOGY LLC
NPI 1508976010
Dermatology in St Petersburg, FL

Q: What is Divine Dermatology LLC's NPI number?

The NPI number for Divine Dermatology LLC is 1508976010. It was assigned to this organization in the NPPES registry on August 30, 2006. The provider is doing business as Prime Dermatology.

Q: What is Divine Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Active since August 30, 2006CLIA 10D2332078 · Certificate of Compliance

2191 9TH AVE N STE 100, ST PETERSBURG, FL 33713(727) 528-0321(727) 498-8832 Get Directions Write a Review

NPPES record last updated: October 15, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 15, 2026, Jun 4, 2026 (2 updates tracked since 2026).

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About Divine Dermatology Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVINE DERMATOLOGY LLC (NPI 1508976010), doing business as Prime Dermatology, is a healthcare organization registered as a dermatology in St Petersburg, Florida and active in the NPI registry since August 2006. The organization holds a CLIA Certificate of Compliance certificate valid through October 13, 2027 and lists Neha Chandan, Owner, as its authorized official.

NPPES Registry Identity

NPI1508976010

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameDIVINE DERMATOLOGY LLC

Location Address2191 9TH AVE N STE 100St Petersburg, FL 33713-7147

Mailing Address2191 9th Ave N Ste 100St Petersburg, FL 33713-7147 · (727) 528-0321 · Fax (727) 498-8832

Phone(727) 528-0321

Fax(727) 498-8832

Organization SubpartNo

Authorized OfficialNeha ChandanOwner · (727) 528-0321

Enumeration DateAugust 30, 2006

Last NPPES UpdateOctober 15, 20262 updates tracked since enumeration

NPPES CertifiedOctober 15, 2026

✔ NPI 1508976010 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in FL · ME87149

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X

2191 9TH AVE N STE 100, St Petersburg, FL 33713

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Other Names 1

Doing Business AsPrime Dermatology

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AmeriHealth Caritas Next, Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

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 Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Divine Dermatology LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Neha Chandan, MD

Dermatology

NPI 1114554870

2191 9TH AVE N STE 100
St Petersburg, FL 33713

(727) 528-0321

✔ PECOS✔ Accepts MedicareSame address

Alexandra Summitt, D.N.P.

Nurse Practitioner

NPI 1255981338

2191 9TH AVE N STE 100
St Petersburg, FL 33713

(727) 528-0321

✔ PECOS✔ Accepts MedicareSame address

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 Compliance 10D2332078

Divine Dermatology PLLC · Saint Petersburg, FL

Active · expires Oct 13, 2027

CLIA Number10D2332078

Laboratory TypePhysician Office

Certificate Effective DateOctober 14, 2025

Certificate Expiration DateOctober 13, 2027

Laboratory DirectorNeha Chandan

Laboratory Phone(727) 528-0321

Laboratory LocationDivine Dermatology PLLC2191 9th Ave N Suite 100, Saint Petersburg, FL 33713

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 LLC's NPI number?

The NPI number for Divine Dermatology LLC is 1508976010. It was assigned to this organization in the NPPES registry on August 30, 2006. The provider is doing business as Prime Dermatology.

Where is Divine Dermatology LLC located?

Divine Dermatology LLC is located at 2191 9th Ave N Ste 100, St Petersburg, FL 33713. The listed phone number is (727) 528-0321.

What is Divine Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Divine Dermatology LLC enrolled in Medicare?

Yes. Divine Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Divine Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Divine Dermatology LLC, in Dermatology and Nurse Practitioner. 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Divine Dermatology LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 10D2332078) is associated with this NPI, valid through October 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Divine Dermatology LLC accept?

Health plans from AmeriHealth Caritas Next and Florida Blue HMO (a BlueCross BlueShield FL company) list Divine Dermatology LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Divine Dermatology LLC was last updated on October 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 days 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.