Revive & Rejuvenate LLC Bluvida

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

REVIVE & REJUVENATE LLC BLUVIDA

Practice address

3129 Kingsley Dr Ste 640
Pearland, TX 77584-8508

Phone

(281) 901-1133

Fax

(281) 901-1601

NPI assigned

Dec 23, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Lee, MDNPI 1932470689

Title

Owner

Phone

(785) 550-1239

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Stephen Lee, M.D.

  • Nephrology Physician
  • Pearland, TX
  • NPI 1932470689
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1577059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1225677222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 ALMEDA RD, PO BOX 8321",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770044869",
            "telephone_number": "785-550-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3129 KINGSLEY DR STE 640",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775848508",
            "telephone_number": "281-901-1133",
            "fax_number": "281-901-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE & REJUVENATE LLC BLUVIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-23",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-550-1239",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Pearland, TX
• Providers in Pearland, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.