Revive PCMS Florida LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVIVE PCMS FLORIDA LLC

Practice address

21859 State Road 54
Lutz, FL 33549-6924

Phone

(813) 382-8747

Fax

(888) 355-6731

NPI assigned

Jul 23, 2025

Last updated

Oct 30, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Zahid Jamal

Title

Owner

Phone

(813) 482-1688

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lindsay Wiberly, MSN, APRN, FNP-BC

  • Family Nurse Practitioner
  • Lutz, FL
  • NPI 1659197317
  Medicare reassignment NPD
• Kyle Kalra, DO

  • Family Medicine Physician
  • Highland Village, TX
  • NPI 1568967909

  FL

  Medicare reassignment NPD
• Charles David Talakkottur, M.D.

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1598949034
  Medicare reassignment

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

{
    "created_epoch": "1753228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761782400000",
    "number": "1386526978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21859 STATE ROAD 54",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335496924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21859 STATE ROAD 54",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335496924",
            "telephone_number": "813-382-8747",
            "fax_number": "888-355-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE PCMS FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-23",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A",
        "authorized_official_last_name": "JAMAL",
        "authorized_official_first_name": "ZAHID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-482-1688"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Claudia Reyes Toranzo, RBT
• Liezl Xyra Canoneo Reyes, P.T.
• Remounda Rezk
• Ellamy Lynne Rhoads, PHARMD
• Charles R. Rhodes, L.M.H.C.

• Family Medicine Physician in Lutz, FL
• Providers in Lutz, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.