Active NPI
John P Revord, MD
- Physical Medicine & Rehabilitation Physician
- Appleton, WI
National Provider Identifier
1922090141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 32952
- Practice address
- 5320 Michaels Dr
Appleton, WI 54913-8446 - Phone
- (920) 882-8200
- Fax
- (920) 882-8210
- NPI assigned
- Aug 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 32952 | WI | Primary |
Addresses
Primary practice location
5320 Michaels Dr
Appleton, WI 54913-8446
Mailing address
5320 Michaels Dr
Appleton, WI 54913-8446
Phone (920) 882-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31795300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32952 | WI | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360540800000",
"number": "1922090141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5320 MICHAELS DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549138446",
"telephone_number": "920-882-8200",
"fax_number": "920-882-8210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5320 MICHAELS DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549138446",
"telephone_number": "920-882-8200",
"fax_number": "920-882-8210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVORD",
"first_name": "JOHN",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-16",
"last_updated": "2013-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "WI",
"license": "32952",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31795300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
- Kathleen Ann Reschar, MS, CCC-SLP
- Rest and Rise Respite Services LLC
- Grahme Joseph Retzlaff
- Revamp Hormone Repalcement and Medical Weight Loss
- Revitalize Counseling Services
- Julie Ann Lisa Reynolds, APNP-BC
- Mary L Reynolds, REGISTERED NURSE
- Nancy Grace Rezmer, MS, LMT
- Ria Behavioral Health LTD
- Richard J. Schoengarth DDS SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.