Revive Medical Group, P.C.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

REVIVE MEDICAL GROUP, P.C.

Practice address

1600 N 2ND St
Clinton, MO 64735-1192

Phone

(203) 430-1321

NPI assigned

Apr 7, 2021

Organization subpart

No

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

Authorized official

Name

Omar Ziyadeh

Title

PC Manager

Phone

(203) 430-1321

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1033798871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 REEF RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246538",
            "telephone_number": "203-430-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "203-430-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "ZIYADEH",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "PC MANAGER",
        "authorized_official_telephone_number": "203-430-1321"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Lee Reger, PA-C
• Zahra M Rehman, M.D.
• Hannah Helen Reid, SLPA
• Lawrence Edward Reilly, PLPC
• Restore Counseling LLC
• Heather A Richter, LPC
• Ashley Ritter, BT
• David Alan Rivas, MSW
• Madeline Roberts, OTR
• Stephaney Robinson, RBT

• Psychiatry Physician in Clinton, MO
• Providers in Clinton, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.