Individual provider Active NPI

Lynnette Renee Reville, M.A., CCC-A

  • Audiologist
  • Melbourne, FL
National Provider Identifier
1316110216
Registry record updated Feb 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AY000498 Issued in FL
Practice address
1325 South Apollo
Melbourne, FL 32901
Phone
(321) 508-6455
NPI assigned
Apr 11, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AY000498 FL Primary

Addresses

Primary practice location

1325 South Apollo
Melbourne, FL 32901

Mailing address

1325 S.Apollo
Dr Blenda Dickenson
Melbourne, FL 32901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160620000213 VA Practitioner - Qualified Audiologist 9032285069 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

1755 N Mecklenburg Ave
South Hill, VA 23970-4080
Phone (434) 447-3151

Merit-based Incentive Payment System (MIPS)

Final score
85.74 of 100Reported as group
Quality
74.5
Promoting interoperability
100
Improvement activities
40
Cost
77.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
AY000498FLMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
CMH Physician Services, LLC CurrentSince Apr 11, 2016 Accepting new patients
MCV Associated Physicians CurrentSince Dec 10, 2024 Accepting new patients
CMH Physician Services, LLC CurrentSince Apr 11, 2016 Accepting new patients
Hearusa Inc PastSince Oct 13, 2013 Accepting new patients

Locations

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

1755 N Mecklenburg Ave
South Hill, VA 23970
Phone (434) 584-2273

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391472000000",
    "number": "1316110216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 S.APOLLO",
            "address_2": "DR BLENDA DICKENSON",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SOUTH APOLLO",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "321-508-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVILLE",
        "first_name": "LYNNETTE",
        "middle_name": "RENEE",
        "credential": "M.A., CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-11",
        "last_updated": "2014-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "FL",
            "license": "AY000498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.