Revivex Healthcare Inc

Primary specialty

Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X

Legal business name

REVIVEX HEALTHCARE INC

Doing business as

Pacific Pain & Wellness Group

Practice address

23510 Crenshaw Blvd Ste 100
Torrance, CA 90505-5203

Phone

(310) 437-7399

Fax

(310) 437-7398

NPI assigned

Nov 15, 2011

Last updated

Mar 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kartik Ananth, MDNPI 1821279423

Title

President

Phone

(310) 437-7399

Specialties & licenses 5

Addresses

Other names 1

• PACIFIC PAIN & WELLNESS GROUP Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

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.

• Revivex Healthcare Inc

  dba Pacific Pain & Wellness Group

  • Non-Pharmacy Dispensing Site
  • Torrance, CA
  • NPI 1083087613
  NPD tax ID

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 6

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.

• Kartik Ananth, MD

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Torrance, CA
  • NPI 1821279423
  Medicare reassignment Care Compare group NPD Authorized official
• Gelareh Solomon, PH.D

  • Clinical Psychologist
  • Torrance, CA
  • NPI 1457582140
  Medicare reassignment Care Compare group NPD
• Steve S. Im, MD

  • Anesthesiology Physician
  • Cerritos, CA
  • NPI 1114019544
  Medicare reassignment NPD
• Josefina Reyes

  • Psychiatric/Mental Health Nurse Practitioner
  • Torrance, CA
  • NPI 1376825158
  Medicare reassignment NPD
• Rachel Ann Ardoin, NP

  • Nurse Practitioner
  • Santa Fe Springs, CA
  • NPI 1124634563
  NPD (past)
• Sumera Chaggan, PA

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Torrance, CA
  • NPI 1144702887
  NPD (past)

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

{
    "created_epoch": "1321315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1174800452",
    "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": "310-437-7399",
            "fax_number": "104-377-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23510 CRENSHAW BLVD STE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055203",
            "telephone_number": "310-437-7399",
            "fax_number": "310-437-7398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVEX HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-15",
        "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": "PRESIDENT",
        "authorized_official_telephone_number": "310-437-7399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACIFIC PAIN & WELLNESS GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Richard a. Retodo, D.M.D
• Nancy Jo Rettig, LMFT
• Reinald Allen Revilla, PMHNP
• Revive Wellness Center
• Revivex Healthcare Inc (Pacific Pain & Wellness Group)
• Ulyssa Revolvo
• Stephanie Rey, STEPHANIE
• Juana Reyes Andrade
• Brenda Reyes Guevara
• Ana Reyes Vaquiz

• Pain Medicine (Psychiatry & Neurology) Physician in Torrance, CA
• Providers in Torrance, CA by specialty
• Pain Medicine (Psychiatry & Neurology) Physician in California

• 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 enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.