Revive Medical, PLLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

Legal business name

REVIVE MEDICAL, PLLC

Practice address

12285 Pellicano Drive
Suite A2
El Paso, TX 79936

Phone

(915) 248-4863

Fax

(855) 891-7827

NPI assigned

Nov 10, 2021

Organization subpart

No

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

Authorized official

Name

Clifford Owen Janke, MD

Title

Medical Director

Phone

(915) 248-4863

Specialties & licenses 9

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1679239180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12285 PELLICANO DRIVE",
            "address_2": "SUITE A2",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79936",
            "telephone_number": "915-248-4863",
            "fax_number": "855-891-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12285 PELLICANO DRIVE",
            "address_2": "SUITE A2",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79936",
            "telephone_number": "915-248-4863",
            "fax_number": "855-891-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "JANKE",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "OWEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "915-248-4863",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333300000X",
            "taxonomy_group": "",
            "desc": "Emergency Response System Companies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Reveles
• Rodolfo Manuel Revilla
• Revive Global PLLC
• Revive Home Care Inc.
• Revive Home Care Inc.
• Kathryn L Revtyak, LCSW
• Beatriz Rey Garcia
• Briana Lauren Rey Kolstad, PC PNP
• Alyssa Michelle Rey
• Eduardo Jesus Rey Jr.

• Emergency Care Clinic/Center in El Paso, TX
• Providers in El Paso, TX by specialty
• Emergency Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.