Revive Medical Supplies

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

REVIVE MEDICAL SUPPLIES

Practice address

1617 S Burlington Ave
Los Angeles, CA 90006-2567

Phone

(949) 390-9105

NPI assigned

May 5, 2020

Organization subpart

No

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

Authorized official

Name

Cory Jacobsen, MBA

Title

Ceo

Phone

(949) 390-9105

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

Locations

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1467073098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 811457",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900810008",
            "telephone_number": "949-390-9105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 S BURLINGTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062567",
            "telephone_number": "949-390-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL SUPPLIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-05",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "CORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-390-9105",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Revital Care Hospice, Inc.
• Revival Health Medical Group
• Revival Health Medical Group PA
• Revive Detox
• Revive Health. Inc
• Revive Wellness Counseling Center
• Revive Wellness Family Counseling
• Cheryl R Revkin, D.C.
• David Edward Rex, M. D., PH. D.
• Jessica Rexach, M.D., PH.D

• Durable Medical Equipment & Medical Supplies in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.