Active NPI
Revolution Health PC
- Primary Care Clinic/Center
- Sturgis, MI
National Provider Identifier
1366091670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- Legal business name
- REVOLUTION HEALTH PC
- Practice address
- 104 S Lakeview Ave
Sturgis, MI 49091-1947 - Phone
- (269) 319-8850
- Fax
- (269) 464-0101
- NPI assigned
- Sep 9, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Steven John Klingler
- Title
- Office Manager
- Phone
- (269) 716-1890
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Primary |
Addresses
Primary practice location
104 S Lakeview Ave
Sturgis, MI 49091-1947
Mailing address
104 S Lakeview Ave
Sturgis, MI 49091-1947
Phone (269) 319-8850
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | info@revolutionhealthpc.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191126001789 | MI | Part B Supplier - Clinic/Group Practice | 2264865633 |
Receives reassigned benefits from 15 practitioners 1 other NPI on this enrollment Practice locations: Colon, MI; Sturgis, MI |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2171844 | Revolution Health | Provider-performed microscopy | Sep 9, 2027 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 16
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567987200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1567987200000",
"number": "1366091670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 S LAKEVIEW AVE",
"city": "STURGIS",
"state": "MI",
"postal_code": "490911947",
"telephone_number": "269-319-8850",
"fax_number": "269-464-0101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S LAKEVIEW AVE",
"city": "STURGIS",
"state": "MI",
"postal_code": "490911947",
"telephone_number": "269-319-8850",
"fax_number": "269-464-0101"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVOLUTION HEALTH PC",
"organizational_subpart": "NO",
"enumeration_date": "2019-09-09",
"last_updated": "2019-09-09",
"status": "A",
"authorized_official_last_name": "KLINGLER",
"authorized_official_first_name": "STEVEN",
"authorized_official_middle_name": "JOHN",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "269-716-1890"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "info@revolutionhealthpc.com",
"affiliation": "N",
"address_1": "104 S Lakeview Ave",
"city": "Sturgis",
"state": "MI",
"country_code": "US",
"postal_code": "490911947",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Sturgis, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; 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.