Active NPI
Revamed Clewiston
- Rural Health Clinic/Center
- Clewiston, FL
National Provider Identifier
1811789696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- REVAMED CLEWISTON
- Practice address
- 406 S Deane Duff Ave
Clewiston, FL 33440-3818 - Phone
- (863) 983-5453
- NPI assigned
- May 19, 2025
- Last updated
- May 19, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Nathalie Bastien-Montpeirous, M.D.
- Title
- Medical Director
- Phone
- (863) 983-5453
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | NU | ||
| Rural Health Clinic/Center | 261QR1300X | NU | Primary |
Addresses
Primary practice location
406 S Deane Duff Ave
Clewiston, FL 33440-3818
Mailing address
406 S Deane Duff Ave
Clewiston, FL 33440-3818
Phone (863) 983-5453
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013400900 | Medicaid | FL | |
| 1598062630 | Other | NPI |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
-
- Internal Medicine Physician
- Boynton Beach, FL
- NPI 1598062630
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747612800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747612800000",
"number": "1811789696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 S DEANE DUFF AVE",
"city": "CLEWISTON",
"state": "FL",
"postal_code": "334403818",
"telephone_number": "863-983-5453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 S DEANE DUFF AVE",
"city": "CLEWISTON",
"state": "FL",
"postal_code": "334403818",
"telephone_number": "863-983-5453"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVAMED CLEWISTON",
"organizational_subpart": "NO",
"enumeration_date": "2025-05-19",
"last_updated": "2025-05-19",
"certification_date": "2025-05-19",
"status": "A",
"authorized_official_last_name": "BASTIEN-MONTPEIROUS",
"authorized_official_first_name": "NATHALIE",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "863-983-5453",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "013400900",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1598062630",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Clewiston, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.