REVIVE DERMATOLOGY CLINIC AND SPA
NPI 1205479888
Nurse Practitioner - Family in Ankeny, IA
About Revive Dermatology Clinic And Spa NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVIVE DERMATOLOGY CLINIC AND SPA (NPI 1205479888) is a healthcare organization registered as a family in Ankeny, Iowa and active in the NPI registry since October 2019. The organization holds a CLIA Waiver certificate valid through March 24, 2027 and lists Stefanie Gatica, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Revive Dermatology Clinic And Spa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Revive Dermatology Clinic And Spa, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 16D2218040
Revive Dermatology Clinic And Spa · Ankeny, IAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Revive Clinic And Spa's NPI number?
The NPI number for Revive Clinic And Spa is 1205479888. It was assigned to this organization in the NPPES registry on October 25, 2019. The provider is doing business as Revive Dermatology Clinic And Spa.
Where is Revive Clinic And Spa located?
Revive Clinic And Spa is located at 1850 SW Plaza Shops Ln Ste A, Ankeny, IA 50023. The listed phone number is (515) 965-5677.
What is Revive Clinic And Spa's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Revive Clinic And Spa enrolled in Medicare?
Yes. Revive Clinic And Spa is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revive Clinic And Spa?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Revive Clinic And Spa. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Revive Clinic And Spa hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 16D2218040) is associated with this NPI, valid through March 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Revive Clinic And Spa was last updated on August 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Revive Dermatology Clinic And Spa · NPI 1205479888
Family organization in Ankeny, Iowa. Organization record, active in the CMS NPPES registry since October 25, 2019.
## Identity
- **NPI:** 1205479888 (Entity type: Organization)
- **Enumerated:** October 25, 2019
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Legal business name:** Revive Clinic And Spa
- **Organization subpart:** No
- **Authorized official:** Stefanie Gatica, OWNER
## Practice location
- **Address:** 1850 SW PLAZA SHOPS LN STE A, Ankeny, IA 50023-7168
- **Phone:** (515) 965-5677
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 14, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1205479888) · Data from the CMS NPPES public registry.