Revlis Medical, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

REVLIS MEDICAL, LLC

Practice address

1040 Edgewater Pkwy Ste 104
Suite 104
Indian Land, SC 29707-4526

Phone

(845) 551-8166

NPI assigned

Apr 7, 2021

Organization subpart

No

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

Authorized official

Name

Michael McKeown, DCNPI 1518043082

Title

Manager

Phone

(845) 551-8166

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 3

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

• Michael Anthony McKeown, D.C.

  • Chiropractor
  • Monroe, NY
  • NPI 1518043082

  SC

  Medicare reassignment Care Compare group NPD Authorized official
• Alexa-Gail Ruth-Ann Woolery

  • Family Nurse Practitioner
  • Indian Land, SC
  • NPI 1053000927
  Medicare reassignment Care Compare group NPD
• Heather Elizabeth Shiflett, PA-C

  • Physician Assistant
  • Fort Mill, SC
  • NPI 1619901568
  NPD

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1386223196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER PKWY",
            "address_2": "SUITE 104",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297074526",
            "telephone_number": "845-551-8166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 EDGEWATER PKWY STE 104",
            "address_2": "SUITE 104",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297074526",
            "telephone_number": "845-551-8166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVLIS MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "MCKEOWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "845-551-8166",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY LICENSE #",
            "identifier": "X010814",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.revlismedical.com",
            "affiliation": "N",
            "endpointDescription": "Website URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1040 Edgewater Corporate Pkwy Ste 104",
            "city": "Indian Land",
            "state": "SC",
            "country_code": "US",
            "postal_code": "297074526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Indian Land, SC
• Providers in Indian Land, SC by specialty
• Physical Medicine & Rehabilitation Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.