Michael Allen Revelle, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD34579 Issued in TN

Practice address

708 W Forest Ave
Jackson, TN 38301-3901

Phone

(731) 660-8759

NPI assigned

Jan 13, 2006

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Emergency Medical Care Facilities PC

  • Emergency Medicine Physician
  • Jackson, TN
  • NPI 1538345855
  Medicare reassignment NPD
• J&J Health Services, LLC

  • Family Medicine Physician
  • Medina, TN
  • NPI 1710792940
  Medicare reassignment NPD
• PA Corporate Enterprises, LLP

  • Rural Health Clinic/Center
  • Greenfield, TN
  • NPI 1518226646
  Medicare reassignment NPD
• P a Corporate Enterprises LLP

  • Multi-Specialty Clinic/Center
  • Medina, TN
  • NPI 1598201196
  NPD
• Bolivar General Hospital, Inc.

  • General Acute Care Hospital
  • Bolivar, TN
  • NPI 1174545446
  NPD (past)
• Bolivar General Hospital, Inc.

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950
  NPD (past)
• Decatur County General Hospital

  • General Acute Care Hospital
  • Parsons, TN
  • NPI 1104804566
  NPD (past)
• Jackson Madison County General Hospital

  • General Practice Physician
  • Jackson, TN
  • NPI 1467493916

  Emergency Medicine

  NPD (past)
• Robert C. Stephenson, M.D.,P.C.

  • Emergency Medicine Physician
  • Paris, TN
  • NPI 1740332329
  NPD (past)

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247702400000",
    "number": "1295714558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 HIGHWAY 45 BYP",
            "address_2": "SUITE 604",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054436",
            "telephone_number": "731-660-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013901",
            "telephone_number": "731-660-8759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELLE",
        "first_name": "MICHAEL",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2009-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "MD34579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00109858",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3861019",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4032737",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam David Reinhard
• Amanda Reiter, MD
• Jonathan Renfroe, PHARM.D.
• Retina Consultants, P.C.
• Revelation of Hope Counseling Services, LLC
• Kristin Herron Reynolds
• Rha Health Services TN, LLC
• Rha Trenton Mr Inc.
• Rha Trenton Mr Inc.
• Rha Trenton Mr Inc.

• Emergency Medicine Physician in Jackson, TN
• Providers in Jackson, TN by specialty
• Emergency Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; 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.