REVITALIZE HYDRATION THERAPY, LLC
NPI 1285261123
Nurse Practitioner - Gerontology in Flowood, MS
About Revitalize Hydration Therapy, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVITALIZE HYDRATION THERAPY, LLC (NPI 1285261123) is a healthcare organization registered as a gerontology in Flowood, Mississippi and active in the NPI registry since March 2020. The organization holds a CLIA Waiver certificate valid through September 22, 2027 and lists Jennye Mardis, Staff, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Revitalize Hydration Therapy, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Revitalize Hydration Therapy, LLC, which bills Medicare for the services they deliver. Of these, 7 practice within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 3
Clinicians, nearest first (12)
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 25D2172355
Revitalize Hydration Therapy · Flowood, MSFrequently 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 Revitalize Hydration Therapy, LLC's NPI number?
The NPI number for Revitalize Hydration Therapy, LLC is 1285261123. It was assigned to this organization in the NPPES registry on March 23, 2020.
Where is Revitalize Hydration Therapy, LLC located?
Revitalize Hydration Therapy, LLC is located at 885 Liberty Rd Ste 300, Flowood, MS 39232. The listed phone number is (601) 213-0069.
What is Revitalize Hydration Therapy, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Revitalize Hydration Therapy, LLC enrolled in Medicare?
Yes. Revitalize Hydration Therapy, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revitalize Hydration Therapy, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians in 3 Medicare specialties reassign their Medicare billing to Revitalize Hydration Therapy, LLC. 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. The largest specialties are Nurse Practitioner (10), Emergency Medicine (1) and Infectious Disease (1). Of these, 7 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Revitalize Hydration Therapy, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D2172355) is associated with this NPI, valid through September 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Revitalize Hydration Therapy, LLC accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Revitalize Hydration Therapy, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Revitalize Hydration Therapy, LLC was last updated on November 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Revitalize Hydration Therapy, Llc · NPI 1285261123
Gerontology organization in Flowood, Mississippi. Organization record, active in the CMS NPPES registry since March 23, 2020.
## Identity
- **NPI:** 1285261123 (Entity type: Organization)
- **Enumerated:** March 23, 2020
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **Organization subpart:** No
- **Authorized official:** Jennye Mardis, STAFF
## Practice location
- **Address:** 885 LIBERTY RD STE 300, Flowood, MS 39232-9006
- **Phone:** (601) 213-0069
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 12 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (10), Emergency Medicine (1), Infectious Disease (1); 7 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 10, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1285261123) · Data from the CMS NPPES public registry.