REVIVED MEDICAL COMMUNITY CLINIC
NPI 1306653688
Clinic/Center in Florence, SC
About Revived Medical Community Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVIVED MEDICAL COMMUNITY CLINIC (NPI 1306653688) is a healthcare organization registered as a clinic/center in Florence, South Carolina and active in the NPI registry since December 2024. The organization holds a CLIA Waiver certificate valid through June 22, 2028 and lists Lavanda Martin, Ceo,owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Revived Medical Community Clinic 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 Revived Medical Community Clinic, 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 42D2346008
Revived Medical Community Clinic · Florence, SCFrequently 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 Revived Medical Community Clinic's NPI number?
The NPI number for Revived Medical Community Clinic is 1306653688. It was assigned to this organization in the NPPES registry on December 11, 2024.
Where is Revived Medical Community Clinic located?
Revived Medical Community Clinic is located at 2724 W Palmetto St Ste 5, Florence, SC 29501. The listed phone number is (843) 799-2649.
What is Revived Medical Community Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Revived Medical Community Clinic enrolled in Medicare?
Yes. Revived Medical Community Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revived Medical Community Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Revived Medical Community Clinic. 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 Revived Medical Community Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 42D2346008) is associated with this NPI, valid through June 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Revived Medical Community Clinic was last updated on January 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.
# Revived Medical Community Clinic · NPI 1306653688
Clinic/Center organization in Florence, South Carolina. Organization record, active in the CMS NPPES registry since December 11, 2024.
## Identity
- **NPI:** 1306653688 (Entity type: Organization)
- **Enumerated:** December 11, 2024
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Lavanda Martin, CEO,OWNER
## Practice location
- **Address:** 2724 W PALMETTO ST STE 5, Florence, SC 29501-4909
- **Phone:** (843) 799-2649
## 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:** January 6, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1306653688) · Data from the CMS NPPES public registry.