Revive Primary Care & Med Spa is a medicare enrolled "Internal Medicine" provider in Highland Village, Texas. Their current practice location is
2570 Fm 407 Ste 160, Highland Village, Texas. You can reach out to their office (for appointments etc.) via phone at
(214) 930-1659.
Revive Primary Care & Med Spa is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Revive Primary Care & Med Spa
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1669237798.
Healthcare Provider's Profile
| Full Name | Revive Primary Care & Med Spa |
|---|
| Type | Facility |
|---|
| Speciality | Internal Medicine |
|---|
| Location | 2570 Fm 407 Ste 160, Highland Village, Texas |
|---|
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1669237798
- Provider Enumeration Date: 02/19/2024
- Last Update Date: 08/30/2024
Medicare PECOS Information:
- PECOS PAC ID: 7618419920
- Enrollment ID: O20240601000564
Medical Identifiers
Medical identifiers for Revive Primary Care & Med Spa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1669237798 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 111N00000X | Chiropractor | (* (Not Available)) | Secondary |
| 207P00000X | Emergency Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Revive Primary Care & Med Spa acts as a billing entity for following providers:
| Provider Name | Aiman Shokr |
|---|
| Provider Type | Practitioner - Emergency Medicine |
|---|
| Provider Identifiers | NPI Number: 1164748810
PECOS PAC ID: 1951545219
Enrollment ID: I20150728004786 |
|---|
| Provider Name | Jenny Bernier Fugere |
|---|
| Provider Type | Practitioner - Nurse Practitioner |
|---|
| Provider Identifiers | NPI Number: 1679697627
PECOS PAC ID: 3072852615
Enrollment ID: I20190227000097 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Revive Primary Care & Med Spa is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Revive Primary Care & Med Spa
916 Saint Mark Dr,
Murphy, TX 75094-5120
Ph: () - | Revive Primary Care & Med Spa
2570 Fm 407 Ste 160,
Highland Village, TX 75077-3055
Ph: (214) 930-1659 |
Reviews and Comments