Revan Health LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVAN HEALTH LLC

Practice address

5601 NW 72ND St Ste 142
Warr Acres, OK 73132-5924

Phone

(405) 896-7975

Fax

(866) 473-0490

NPI assigned

May 19, 2020

Organization subpart

No

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

Authorized official

Name

Justin Evans

Title

Ceo

Phone

(405) 896-7975

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chris M Sholer, MD

  • Nephrology Physician
  • Oklahoma City, OK
  • NPI 1326047226
  Medicare reassignment
• Carla L Lacy, PHARMD

  • Pharmacist
  • Warr Acres, OK
  • NPI 1811583008
  NPD
• Jason Robert Revel, PHARM.D.

  • Pharmacist
  • Warr Acres, OK
  • NPI 1639347313
  NPD
• Sara Lacy-Antonelli, APRN, NP-C

  • Family Nurse Practitioner
  • Oklahoma City, OK
  • NPI 1235759291
  NPD (past)

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

{
    "created_epoch": "1589846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1114540689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 NW 72ND ST STE 242",
            "city": "WARR ACRES",
            "state": "OK",
            "postal_code": "731325923",
            "telephone_number": "405-896-7975",
            "fax_number": "866-473-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 NW 72ND ST STE 142",
            "city": "WARR ACRES",
            "state": "OK",
            "postal_code": "731325924",
            "telephone_number": "405-896-7975",
            "fax_number": "866-473-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVAN HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-19",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-896-7975"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200917850A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://patientportal.advancedmd.com/139609/account/logon",
            "affiliation": "Y",
            "endpointDescription": "Patient Portal",
            "affiliationName": "Fulcrum Clinic LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "N/A",
            "address_1": "5601 NW 72nd St Ste 142",
            "city": "Warr Acres",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731325924",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://patientportal.advancedmd.com/146415/account/logon",
            "affiliation": "N",
            "endpointDescription": "Patient Portal",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "5601 NW 72nd St Ste 142",
            "city": "Warr Acres",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731325924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren Elizabeth Raczkowski, PHARMD
• Michael Sylvester Radonski
• Randall Otto Rahill, D.D.S.
• Rediscover You
• Katherine Galgani Rensing, CPNP-PC
• Revan Inc
• Jason Robert Revel, PHARM.D.
• William P Reville, D.D.S.
• Timothy Paul Rothwell, D.D.S.
• Rustee Rutherford

• Family Medicine Physician in Warr Acres, OK
• Providers in Warr Acres, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.