Revive Spine and Pain Care Center, PC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

REVIVE SPINE AND PAIN CARE CENTER, PC

Practice address

11770 Haynes Bridge Rd Unit 205-310
Alpharetta, GA 30009-1966

Phone

(616) 634-5365

NPI assigned

Sep 21, 2022

Organization subpart

No

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

Authorized official

Name

Jada J'Nene Trashon Reese, MDNPI 1497928600

Title

Owner

Phone

(616) 634-5365

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/27445/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jada J'Nene Reese, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Fayetteville, GA
  • NPI 1497928600

  Single Specialty

  Medicare reassignment NPD Authorized official
• Dora Jean-Louis, FNP

  • Family Nurse Practitioner
  • Lawrenceville, GA
  • NPI 1902298086
  Medicare reassignment NPD

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1346963667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 BEACON KNOLL DR",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300226441",
            "telephone_number": "616-634-5365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11770 HAYNES BRIDGE RD UNIT 205-310",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091966",
            "telephone_number": "616-634-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE SPINE AND PAIN CARE CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "JADA",
        "authorized_official_middle_name": "J'NENE TRASHON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-634-5365",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renviva Dialysis Center of North Georgia LLC
• Rep Perimeter Holdings, LLC
• Respond Resource Inc
• Resurgens, LLC
• Revive Counseling Center LLC
• Revue Inc.
• Revue Pharmacy
• Jose Ismael Reyes, MD
• Nicholas Reyes, DC
• Karina Reyna

• Interventional Pain Medicine Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.