NPIMap

Individual provider Active NPI

Sheley Rene' Revis, MD

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1407887573
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9500197 Issued in NC
Practice address
8401 Medical Plaza Dr
Suite 250
Charlotte, NC 28262-8797
Phone
(704) 384-1500
Fax
(704) 384-1525
NPI assigned
Jul 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9500197 NC Primary

Addresses

Primary practice location

8401 Medical Plaza Dr
Suite 250
Charlotte, NC 28262-8797

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-1500

Other identifiers 1

IdentifierTypeStateIssuer
8971329MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address srevis21154@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060921000609 NC Practitioner - Internal Medicine 4082619200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 1992
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Comprehab, IncGroup PAC ID 2769653757, 376 clinicians
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

8401 Medical Plaza Dr
Suite 250
Charlotte, NC 28262-8700
Phone (704) 384-1500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9500197NCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Mercy Health Services, Inc. Internal Medicine Past Accepting new patients
Novant Health Medical Group, LLC Internal Medicine Past Accepting new patients

Locations

8401 Medical Plaza Dr
Ste 220
Charlotte, NC 28262
Phone (704) 384-1390

10030 Gilead Rd
Ste 200
Huntersville, NC 28078
Phone (704) 316-5600

Interoperability endpoints

  • Direct secure messaging: srevis21154@direct.novanthealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1407887573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-1500",
            "fax_number": "704-384-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MEDICAL PLAZA DR",
            "address_2": "SUITE 250",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282628797",
            "telephone_number": "704-384-1500",
            "fax_number": "704-384-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVIS",
        "first_name": "SHELEY",
        "middle_name": "RENE'",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9500197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8971329",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "srevis21154@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "8401 Medical Plaza Dr",
            "address_2": "Suite 250",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282628797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.