Active NPI
Revitalize Alabama L.L.C
- Family Medicine Physician
- Auburn, AL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- REVITALIZE ALABAMA L.L.C
- Practice address
- 105 1St Street
Auburn, AL 36830-0000 - Phone
- (334) 734-7973
- NPI assigned
- Aug 10, 2021
- Last updated
- Oct 6, 2021
- 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
- Mr. Travis Woodley, CRNP
- Title
- President
- Phone
- (334) 734-7973
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NU | Primary |
Addresses
Primary practice location
105 1St Street
Auburn, AL 36830-0000
Mailing address
PO Box 2738
Opelika, AL 36803-2738
Phone (334) 734-7973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL, GA
Enrollment records 2
National Provider Directory
National Provider DirectoryLocations
2298 E University Dr
Ste A202
Auburn, AL 36830
Phone (334) 209-0655
2682 Enterprise Dr
Ste 4
Opelika, AL 36801
840 GA Highway 96
Ste 3300
Warner Robins, GA 31088
Phone (334) 425-0961
Interoperability endpoints
- https://api.platform.athenahealth.com/25105/brand/1/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Family Nurse Practitioner
- Warner Robins, GA
- NPI 1467116079
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628553600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1633478400000",
"number": "1942975180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2738",
"city": "OPELIKA",
"state": "AL",
"postal_code": "368032738",
"telephone_number": "334-734-7973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 1ST STREET",
"city": "AUBURN",
"state": "AL",
"postal_code": "368300000",
"telephone_number": "334-734-7973"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVITALIZE ALABAMA L.L.C",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-10",
"last_updated": "2021-10-06",
"certification_date": "2021-09-22",
"status": "A",
"authorized_official_last_name": "WOODLEY",
"authorized_official_first_name": "TRAVIS",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "334-734-7973",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CRNP"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.