Revive MD PLLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

REVIVE MD PLLC

Practice address

821 Raymond Ave Ste 230
Saint Paul, MN 55114-1503

Phone

(651) 746-4412

NPI assigned

Feb 4, 2021

Organization subpart

No

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

Authorized official

Name

Alfonso Morales, MD

Title

Owner

Phone

(651) 476-4412

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1346832953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7595 CURRELL BLVD UNIT 25404",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252569",
            "telephone_number": "612-730-5196",
            "fax_number": "651-647-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE STE 230",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141503",
            "telephone_number": "651-746-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-476-4412",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia L Reutiman, CRNA
• Amber Reuvers, PA
• Rachel A Revier, MS CF-SLP
• Revival Care LLC
• Revive Couples Counseling
• Reviving Therapy & Consulting LLC
• Patricio F Reyes, M.D.
• Arianna Edith Reyna-Rodriguez
• Sarah Jean Reyna, L.AC.
• Reynolds J. Fischbach II, D.D.S., P.a.

• Interventional Pain Medicine Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Interventional Pain Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.