REVIVE HEALTH PRIMARY & URGENT CARE LLC
NPI 1336004530
Nurse Practitioner - Primary Care in Elyria, OH
About Revive Health Primary & Urgent Care Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVIVE HEALTH PRIMARY & URGENT CARE LLC (NPI 1336004530) is a healthcare organization registered as a primary care in Elyria, Ohio and active in the NPI registry since December 2025. The organization holds a CLIA Waiver certificate valid through January 25, 2028 and lists Candace Lee Bolarinwa, Owner/ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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 Health Primary & Urgent Care Llc 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 Health Primary & Urgent Care LLC, 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 36D2298018
Revive Health Primary & Urgent Care · Elyria, OHFrequently 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 Health Primary & Urgent Care LLC's NPI number?
The NPI number for Revive Health Primary & Urgent Care LLC is 1336004530. It was assigned to this organization in the NPPES registry on December 19, 2025.
Where is Revive Health Primary & Urgent Care LLC located?
Revive Health Primary & Urgent Care LLC is located at 401 Cleveland St, Elyria, OH 44035. The listed phone number is (440) 309-3823.
What is Revive Health Primary & Urgent Care LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Revive Health Primary & Urgent Care LLC enrolled in Medicare?
Yes. Revive Health Primary & Urgent Care LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revive Health Primary & Urgent Care LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Revive Health Primary & Urgent Care 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Revive Health Primary & Urgent Care LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 36D2298018) is associated with this NPI, valid through January 25, 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 Revive Health Primary & Urgent Care LLC was last updated on July 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Revive Health Primary & Urgent Care Llc · NPI 1336004530
Primary Care organization in Elyria, Ohio. Organization record, active in the CMS NPPES registry since December 19, 2025.
## Identity
- **NPI:** 1336004530 (Entity type: Organization)
- **Enumerated:** December 19, 2025
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Organization subpart:** No
- **Authorized official:** Candace Bolarinwa, OWNER/CEO
## Practice location
- **Address:** 401 CLEVELAND ST, Elyria, OH 44035-6143
- **Phone:** (440) 309-3823
## 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:** July 22, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1336004530) · Data from the CMS NPPES public registry.