Active NPI
Timothy John Revell, MD
- Emergency Medicine Physician
- Amarillo, TX
National Provider Identifier
1477735322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 62827
- Practice address
- 9601 Spur 591
Amarillo, TX 79107 - Phone
- (806) 381-7080
- Fax
- (806) 381-0417
- NPI assigned
- Dec 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 62827 | TX | Primary |
Addresses
Primary practice location
9601 Spur 591
Amarillo, TX 79107
Mailing address
9601 Spur 591
Amarillo, TX 79107
Phone (806) 381-7080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TXBG2827 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62827 | TX | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196640000000",
"number": "1477735322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9601 SPUR 591",
"city": "AMARILLO",
"state": "TX",
"postal_code": "79107",
"telephone_number": "806-381-7080",
"fax_number": "806-381-0417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9601 SPUR 591",
"city": "AMARILLO",
"state": "TX",
"postal_code": "79107",
"telephone_number": "806-381-7080",
"fax_number": "806-381-0417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVELL",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-03",
"last_updated": "2007-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "62827",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "TXBG2827",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amarillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.