NPIMap

Organization Active NPI

Revive Med Partners I LLC

  • Family Medicine Physician
  • Highland Village, TX
National Provider Identifier
1881400323
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REVIVE MED PARTNERS I LLC
Practice address
2570 Justin Rd Ste 160
Highland Village, TX 75077-3055
Phone
(972) 236-7060
NPI assigned
Dec 9, 2024
Last updated
Dec 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Authorized official

Name
Kyle KalraNPI 1568967909
Title
Owner
Phone
(972) 236-7060

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2570 Justin Rd Ste 160
Highland Village, TX 75077-3055

Mailing address

2570 Justin Rd Ste 160
Highland Village, TX 75077-3055
Phone (972) 236-7060

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250204002415 TX Part B Supplier - Clinic/Group Practice 1658801832 Receives reassigned benefits from 22 practitioners
Practice locations: Highland Village, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1881400323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 JUSTIN RD STE 160",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750773055",
            "telephone_number": "972-236-7060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2570 JUSTIN RD STE 160",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750773055",
            "telephone_number": "972-236-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MED PARTNERS I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A",
        "authorized_official_last_name": "KALRA",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-236-7060"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Village, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; 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.