I-Revive PLLC

Primary specialty

Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X

Legal business name

I-REVIVE PLLC

Practice address

525 Elliott Ave
Grand Haven, MI 49417-1038

Phone

(616) 566-1603

Fax

(616) 607-8588

NPI assigned

Sep 28, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Amanda M Converse I, LMT, CIMT, CPMTNPI 1205435161

Title

Ceo/Founder

Phone

(616) 377-8893

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• my medical massage Doing business as

Electronic endpoints 2

Practitioners 1

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

• Amanda M Converse I, LMT

  • Massage Therapist
  • Grand Haven, MI
  • NPI 1205435161
  NPD Authorized official

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604534400000",
    "number": "1508473000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 ELLIOTT AVE",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494171038",
            "telephone_number": "616-377-8893",
            "fax_number": "616-607-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ELLIOTT AVE",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494171038",
            "telephone_number": "616-566-1603",
            "fax_number": "616-607-8588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I-REVIVE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A",
        "authorized_official_last_name": "CONVERSE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "616-377-8893",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "LMT, CIMT, CPMT"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14997664",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "support@i-revive.org",
            "affiliation": "N",
            "endpointDescription": "Business  support line",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email support line",
            "address_1": "525 Elliott Ave",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494171038",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "www.support@i-revive.org",
            "affiliation": "N",
            "endpointDescription": "i-Revive support email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "525 Elliott Ave",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494171038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "my medical massage",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "my medical massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Preventive Medicine/Occupational Environmental Medicine Physician in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Preventive Medicine/Occupational Environmental Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.