NPIMap

Organization Active NPI

Revive Transitional Care and in Home Primary Medicine, LLC

  • Family Medicine Physician
  • Orlando, FL
National Provider Identifier
1851096796
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REVIVE TRANSITIONAL CARE AND IN HOME PRIMARY MEDICINE, LLC
Practice address
900 Springwood Dr
Orlando, FL 32839-1318
Phone
(407) 429-1065
NPI assigned
Mar 31, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Maribel Palmer
Title
Authorized Official
Phone
(407) 429-1065

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

900 Springwood Dr
Orlando, FL 32839-1318

Mailing address

612 Corporate Way Ste 2M
Valley Cottage, NY 10989-2027
Phone (718) 362-1411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230607000359 FL Part B Supplier - Clinic/Group Practice 3870950868 Receives reassigned benefits from 5 practitioners
Practice locations: Orlando, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1851096796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 CORPORATE WAY STE 2M",
            "city": "VALLEY COTTAGE",
            "state": "NY",
            "postal_code": "109892027",
            "telephone_number": "718-362-1411",
            "fax_number": "718-362-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SPRINGWOOD DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328391318",
            "telephone_number": "407-429-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE TRANSITIONAL CARE AND IN HOME PRIMARY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-31",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "MARIBEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "407-429-1065"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.