Revive Hydration Spa LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

REVIVE HYDRATION SPA LLC

Doing business as

Revive RX

Practice address

5650 S Franklin Rd Ste 300C
Indianapolis, IN 46239-8620

Phone

(317) 245-7353

Fax

(317) 527-9214

NPI assigned

Jan 16, 2021

Organization subpart

No

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

Authorized official

Name

Jane Archer, NPNPI 1619237476

Title

Owner

Phone

(317) 245-7353

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Revive RX Doing business as
• Revive Hydration LLC-S Other name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 1

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

• Jane Archer, FNP

  • Family Nurse Practitioner
  • Indianapolis, IN
  • NPI 1619237476
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1610755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1225627920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5650 S FRANKLIN RD STE 300C",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462398620",
            "telephone_number": "317-245-7353",
            "fax_number": "317-527-9214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5650 S FRANKLIN RD STE 300C",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462398620",
            "telephone_number": "317-245-7353",
            "fax_number": "317-527-9214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HYDRATION SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-16",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "ARCHER",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-245-7353",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619237476",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive RX",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revive Hydration LLC-S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steffany Reutter, PHARMD
• Revasmedicus Medical LLC
• Gregory T. Reveal, MD
• Milton Revelo, DDS
• Revival Wellness Group LLC
• Revive Medical Group LLC
• George E Revtyak, MD
• Aaliyah Rew
• Douglas K Rex, M.D.
• Ashleigh Marie Rexford, D.M.D

• Health Service Clinic/Center in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Health Service Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; 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.