NPIMap

Organization Active NPI

Revivex Healthcare Inc

Doing business as Pacific Pain & Wellness Group

  • Non-Pharmacy Dispensing Site
  • Torrance, CA
National Provider Identifier
1083087613
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A109016
Legal business name
REVIVEX HEALTHCARE INC
Doing business as
Pacific Pain & Wellness Group
Practice address
23150 Crenshaw Blvd Ste 100
Torrance, CA 90505-3025
Phone
(310) 437-7399
Fax
(888) 431-8819
NPI assigned
Nov 4, 2015
Last updated
Mar 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Kartik AnanthNPI 1821279423
Title
Owner
Phone
(310) 437-7399

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A109016 Primary

Addresses

Primary practice location

23150 Crenshaw Blvd Ste 100
Torrance, CA 90505-3025

Mailing address

23150 Crenshaw Blvd Ste 100
Torrance, CA 90505-3025
Phone (104) 377-3993

Other identifiers 1

IdentifierTypeStateIssuer
2155100OtherPK

Other names 1

  • Pacific Pain & Wellness Group Doing business as

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
05D2072919Pacific Pain & Wellness Group23150 Crenshaw Blvd Ste 100, Torrance, CA 90505Certificate of waiverFeb 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pacific Pain Wellness Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23150 Crenshaw Blvd
Ste 100
Torrance, CA 90505
Phone (310) 381-0024

Practitioners & affiliated clinicians

Practitioners 8

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": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1083087613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23150 CRENSHAW BLVD STE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905053025",
            "telephone_number": "104-377-3993",
            "fax_number": "210-437-7398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23150 CRENSHAW BLVD STE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905053025",
            "telephone_number": "310-437-7399",
            "fax_number": "888-431-8819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVEX HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-04",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "ANANTH",
        "authorized_official_first_name": "KARTIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-437-7399"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": "A109016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155100",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Pain & Wellness Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Pain & Wellness Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Torrance, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.