Individual provider Active NPI

James Clifford Revis, CRNA

  • Certified Registered Nurse Anesthetist
  • Fort Hood, TX
National Provider Identifier
1831716026
Registry record updated Jul 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN282004 Issued in GA
Practice address
36065 Santa Fe Ave
Fort Hood, TX 76544
Phone
(254) 288-8000
NPI assigned
Jul 3, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN282004 GA Primary

Addresses

Primary practice location

36065 Santa Fe Ave
Fort Hood, TX 76544

Mailing address

416 San Gabriel River Rd
Georgetown, TX 78626-2178
Phone (513) 504-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230912000731 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193189025 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Ohio Anesthesia Consultants LLCGroup PAC ID 6901700640, 362 clinicians

Practice addresses (Care Compare)

4777 E Galbraith Rd
Cincinnati, OH 45236-2725
Phone (513) 686-3000

Hospital & facility affiliations

  • The Jewish Hospital-Mercy Health Hospital, Cincinnati, OH, CCN 360016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN282004GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia & Intensive Care Consultants,Inc. Nurse Anesthetist, Certified Registered CurrentSince Aug 16, 2023 Accepting new patients
Southwest Ohio Anesthesia Consultants LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 16, 2023 Accepting new patients

Locations

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

3000 Hospital Dr
Batavia, OH 45103
Phone (513) 557-3209

4777 E Galbraith Rd
Cincinnati, OH 45236
Phone (513) 686-3000

7500 State Rd
Cincinnati, OH 45255
Phone (513) 624-4034

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1593734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593734400000",
    "number": "1831716026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 SAN GABRIEL RIVER RD",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786262178",
            "telephone_number": "513-504-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36065 SANTA FE AVE",
            "city": "FORT HOOD",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "254-288-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVIS",
        "first_name": "JAMES",
        "middle_name": "CLIFFORD",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-03",
        "last_updated": "2020-07-03",
        "certification_date": "2020-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN282004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Hood, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2020; 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.