REVIVAL HEALTH AND WELLNESS CLINIC
NPI 1366241507
Family Medicine in Salem, IL
About Revival Health And Wellness Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVIVAL HEALTH AND WELLNESS CLINIC (NPI 1366241507) is a healthcare organization registered as a family medicine in Salem, Illinois and active in the NPI registry since March 2025. The organization holds a CLIA Waiver certificate valid through June 4, 2028 and lists Crea Rose, Owner/ Provider, 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)
Revival Health And Wellness Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Revival Health And Wellness Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
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 14D2345165
Revival Health And Wellness Clinic · Salem, ILFrequently 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 Revival Health And Wellness Clinic's NPI number?
The NPI number for Revival Health And Wellness Clinic is 1366241507. It was assigned to this organization in the NPPES registry on March 11, 2025.
Where is Revival Health And Wellness Clinic located?
Revival Health And Wellness Clinic is located at 207 E Main St, Salem, IL 62881. The listed phone number is (706) 889-8349.
What is Revival Health And Wellness Clinic's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Revival Health And Wellness Clinic enrolled in Medicare?
Yes. Revival Health And Wellness Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revival Health And Wellness Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Revival Health And Wellness 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Revival Health And Wellness Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 14D2345165) is associated with this NPI, valid through June 4, 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 Revival Health And Wellness Clinic was last updated on June 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.
# Revival Health And Wellness Clinic · NPI 1366241507
Family Medicine organization in Salem, Illinois. Organization record, active in the CMS NPPES registry since March 11, 2025.
## Identity
- **NPI:** 1366241507 (Entity type: Organization)
- **Enumerated:** March 11, 2025
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Crea Rose, OWNER/ PROVIDER
## Practice location
- **Address:** 207 E MAIN ST, Salem, IL 62881-2926
- **Phone:** (706) 889-8349
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 27, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1366241507) · Data from the CMS NPPES public registry.