Nidhi Reva, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110002141 Issued in VA

Practice address

700 S Washington St Ste 300
Alexandria, VA 22314-4287

Phone

(703) 940-3364

Fax

(703) 717-4055

NPI assigned

Dec 2, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2025 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: nidhi.reva@insneurology.directbygreenway.com

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

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1104128735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S WASHINGTON ST STE 300",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223144287",
            "telephone_number": "703-940-3364",
            "fax_number": "703-717-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S WASHINGTON ST STE 300",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223144287",
            "telephone_number": "703-940-3364",
            "fax_number": "703-717-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVA",
        "first_name": "NIDHI",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-02",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002141",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "DC",
            "license": "PA030381",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lauren Retton
• Virginia L Revere, PH.D.
• Revive Clinic LLC
• Stephanie Revollo
• Stephen W Rex, MD
• Nicole Lynn Reybok

• Medical Physician Assistant in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.