Revival Pain Management Inc

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

REVIVAL PAIN MANAGEMENT INC

Practice address

1925 N Bridge St Ste 101
Elkin, NC 28621-2105

Phone

(336) 835-5330

Fax

(336) 835-5337

NPI assigned

Jul 16, 2006

Last updated

Nov 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emidio Michael Novembre, DONPI 1750308664

Title

Practice Owner

Phone

(336) 835-5330

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Emidio Michael Novembre, DO

  • Interventional Pain Medicine Physician
  • Elkin, NC
  • NPI 1750308664
  Medicare reassignment Care Compare group Authorized official
• Ya Xiong, NP

  • Family Nurse Practitioner
  • Elkin, NC
  • NPI 1447043252
  Medicare reassignment Care Compare group NPD
• Laura Ann Luttio, PA

  • Medical Physician Assistant
  • Elkin, NC
  • NPI 1639885106
  Medicare reassignment Care Compare group
• Donna Kay Davis, NP

  • Nurse Practitioner
  • Elkin, NC
  • NPI 1578543997
  Medicare reassignment NPD

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763596800000",
    "number": "1801813712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 N BRIDGE ST STE 101",
            "city": "ELKIN",
            "state": "NC",
            "postal_code": "286212105",
            "telephone_number": "336-835-5330",
            "fax_number": "336-835-5337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 N BRIDGE ST STE 101",
            "city": "ELKIN",
            "state": "NC",
            "postal_code": "286212105",
            "telephone_number": "336-835-5330",
            "fax_number": "336-835-5337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 W Park Dr",
            "address_purpose": "LOCATION",
            "city": "North Wilkesboro",
            "state": "NC",
            "postal_code": "286593564",
            "country_code": "US",
            "telephone_number": "336-835-5330",
            "fax_number": "336-835-5337",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "905 Rockford St Lowr Level",
            "address_purpose": "LOCATION",
            "city": "Mount Airy",
            "state": "NC",
            "postal_code": "270305323",
            "country_code": "US",
            "telephone_number": "336-835-5330",
            "fax_number": "336-835-5337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVAL PAIN MANAGEMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A",
        "authorized_official_last_name": "NOVEMBRE",
        "authorized_official_first_name": "EMIDIO",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "336-835-5330",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Hubert Radford Jr., D.D.S.
• Adrian Nicole Ramey, CNM
• Robin C Ray, M.D.
• Emily Mullis Reid, D.C.
• Renewed Mobility Prosthetics and Orthotics, LLC
• Reza Rezai, MD
• Rha Behavioral Health NC LLC
• Jane Hill Riley, PH. D.
• Richard Gill Ripley
• Robert G Peterson

• Interventional Pain Medicine Physician in Elkin, NC
• Providers in Elkin, NC by specialty
• Interventional Pain Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; 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.