Janet Mary Revels, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95020388 Issued in CA

Practice address

4510 Executive Dr Ste 108
San Diego, CA 92121-3022

Phone

(619) 333-3515

Fax

(619) 362-9903

NPI assigned

Feb 26, 2022

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21563/brand/1/csg/1/fhir/r4

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

• Aloha Integrative Health

  • Psychiatry Physician
  • San Diego, CA
  • NPI 1669016028
  Medicare reassignment NPD

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

{
    "created_epoch": "1645833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711497600000",
    "number": "1225784390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 PHEASANT DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921233325",
            "telephone_number": "619-971-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DR STE 108",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213022",
            "telephone_number": "619-333-3515",
            "fax_number": "619-362-9903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2621 Pheasant Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921233325",
            "country_code": "US",
            "telephone_number": "619-971-0548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVELS",
        "first_name": "JANET",
        "middle_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-26",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95020388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lexie L Revekant, PT, DPT
• Carlos Reveles, LVN
• Shanae Revell
• Thomas Revell
• Chrystine Rae Revelli, FNP-C
• Revival DME Corp
• Revivamed Medical Corporation
• Revive Medical of San Diego
• Revive Medspa
• Revive Psychiatric Center

• Psychiatric/Mental Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.