Revive Medical Center, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

REVIVE MEDICAL CENTER, LLC

Practice address

753 Old Norcross Rd Ste a
Lawrenceville, GA 30046-4312

Phone

(770) 545-8888

Fax

(770) 545-8889

NPI assigned

Jun 26, 2017

Organization subpart

No

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

Authorized official

Name

Michael D SchulmanNPI 1174755300

Title

Owner

Phone

(770) 545-8888

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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

• Michael D Schulman, DC

  • Chiropractor
  • Lawrenceville, GA
  • NPI 1174755300
  Medicare reassignment NPD Authorized official
• Don William Penney, MD

  • Neurological Surgery Physician
  • Lawrenceville, GA
  • NPI 1285704429
  NPD (past)

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750801205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 OLD NORCROSS RD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464312",
            "telephone_number": "770-545-8888",
            "fax_number": "770-545-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 OLD NORCROSS RD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464312",
            "telephone_number": "770-545-8888",
            "fax_number": "770-545-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SCHULMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-545-8888"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.