Paul Revis MD SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036067857 Issued in IL

Legal business name

PAUL REVIS MD SC

Practice address

1055 Featherstone Rd Ste C
Rockford, IL 61107-5904

Phone

(815) 227-1055

Fax

(815) 227-1006

NPI assigned

Jun 11, 2007

Last updated

Mar 16, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Paul Revis, MDNPI 1518984293

Title

Physician

Phone

(815) 227-1055

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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.

• Paul Revis, M.D.

  • Dermatology Physician
  • Rockford, IL
  • NPI 1518984293
  Medicare reassignment Care Compare group NPD Authorized official
• Olivia Lorenz, APRN

  • Family Nurse Practitioner
  • Rockford, IL
  • NPI 1578363354
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773619200000",
    "number": "1952505422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 FEATHERSTONE RD STE C",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075904",
            "telephone_number": "815-227-1055",
            "fax_number": "815-227-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 FEATHERSTONE RD STE C",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075904",
            "telephone_number": "815-227-1055",
            "fax_number": "815-227-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL REVIS MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A",
        "authorized_official_last_name": "REVIS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "815-227-1055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036067857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036067857",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "0010132251",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Velisa J Patel, NP
• Viral Manubhai Patel, O.D.
• Path of Humanity, Inc. (Visiting Angels Rockford IL)
• Patients Choice Medical Center LTD
• Patrick B. Whitaker, D.C., P.C.
• Bart J. Paul, DDS
• Jaison Paul, MD
• Jon A Paul, D.C.
• Paula Tripodi LCSW
• Stacy Renee Pauley, RN, BSN, CHPN

• Dermatology Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2026; 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.