Selina E Revels, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN073465 Issued in GA

Practice address

275 N Main St
Baxley, GA 31513-0516

Phone

(912) 785-7022

Fax

(912) 705-8010

NPI assigned

Sep 9, 2005

Last updated

May 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Medicine of Baxley, IncGroup PAC ID 2264862382, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Appling Healthcare Hospital, Baxley, GA, CCN 110071

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Medicine of Baxley, Inc

  dba Southern Medicine of Baxley

  • Primary Care Clinic/Center
  • Baxley, GA
  • NPI 1578113940
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Baxley and Appling County Hospital Authority

  dba appling healthcare system

  • General Acute Care Hospital
  • Baxley, GA
  • NPI 1861615304
  Care Compare affiliation

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1164416723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 N MAIN ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130516",
            "telephone_number": "912-785-7022",
            "fax_number": "912-705-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 N MAIN ST",
            "city": "BAXLEY",
            "state": "GA",
            "postal_code": "315130516",
            "telephone_number": "912-785-7022",
            "fax_number": "912-705-8010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "204E 15TH ST",
            "address_purpose": "LOCATION",
            "city": "ALMA",
            "state": "GA",
            "postal_code": "315102908",
            "country_code": "US",
            "telephone_number": "912-632-2952",
            "fax_number": "912-632-8682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVELS",
        "first_name": "SELINA",
        "middle_name": "E",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-09",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN073465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000965478A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Precision Labs II LLC
• Ronald S Reagin Sr., DPM
• James Michael Reid, PHARM.D.
• Relicare LLC (ReliCare Ambulance Service)
• Harold Edward Rentz Jr., DMD
• Ridgecare Therapy Services LLC
• RMX Baxley LLC (Restor Metabolix of Appling)
• Ronald S. Reagin,D.P.M.
• Allison Rowell
• Nayleena Marie Rumph

• Nurse Practitioner in Baxley, GA
• Providers in Baxley, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.
• 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.