NPIMap

Organization Active NPI

Revamed Healthcare Partners LLC

  • Internal Medicine Physician
  • Greenacres, FL
National Provider Identifier
1043780067
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
REVAMED HEALTHCARE PARTNERS LLC
Practice address
3084 S Jog Rd
Greenacres, FL 33467-2053
Phone
(561) 708-1760
NPI assigned
Dec 3, 2018
Last updated
Jul 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Authorized official

Name
Melissa Stieler
Title
Practice Operations Specialist
Phone
(561) 432-2164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3084 S Jog Rd
Greenacres, FL 33467-2053

Mailing address

8132 Okeechobee Blvd Ste B
West Palm Beach, FL 33411-2000
Phone (561) 290-1181

Other practice location 1

6056 Boynton Beach Blvd Ste 115
Boynton Beach, FL 33437-3500
Phone (561) 708-1760

Other practice location 2

7000 W Palmetto Park Rd Ste 201
Boca Raton, FL 33433-3430
Phone (561) 708-1760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190606001846 FL Part B Supplier - Clinic/Group Practice 5395078323 Receives reassigned benefits from 12 practitioners
Practice locations: Boca Raton, FL; Boynton Beach, FL; Greenacres, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2176655Revamed Healthcare Partners, LLC3084 S Jog Road, Greenacres, FL 33467Certificate of waiverDec 18, 2027

National Provider Directory

National Provider Directory

Locations

6238 Atlantic Ave
Ste 3
Delray Beach, FL 33484
Phone (561) 708-1760

Networks

  • HealthSun Health Plans Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11640/brand/10/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1043780067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8132 OKEECHOBEE BLVD STE B",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334112000",
            "telephone_number": "561-290-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3084 S JOG RD",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334672053",
            "telephone_number": "561-708-1760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6056 Boynton Beach Blvd Ste 115",
            "address_purpose": "LOCATION",
            "city": "Boynton Beach",
            "state": "FL",
            "postal_code": "334373500",
            "country_code": "US",
            "telephone_number": "561-708-1760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7000 W Palmetto Park Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334333430",
            "country_code": "US",
            "telephone_number": "561-708-1760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVAMED HEALTHCARE PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A",
        "authorized_official_last_name": "STIELER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "PRACTICE OPERATIONS SPECIALIST",
        "authorized_official_telephone_number": "561-432-2164"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenacres, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.