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REVITALIZE SPINE & SPORTS CARE PLLC
NPI 1407430317
Physical Medicine & Rehabilitation - Pain Medicine in Kennewick, WA

Active since May 06, 2021
4309 W 27TH PL STE 202, KENNEWICK, WA 99338(509) 591-4966 Get Directions Write a Review

NPPES record last updated: May 6, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Revitalize Spine & Sports Care Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVITALIZE SPINE & SPORTS CARE PLLC (NPI 1407430317) is a healthcare organization registered as a pain medicine in Kennewick, Washington and active in the NPI registry since May 2021. The organization lists John Groner, Owner / Md, as its authorized official.

NPPES Registry Identity

NPI1407430317
Entity TypeOrganization
Primary Taxonomy2081P2900X
Legal Business NameREVITALIZE SPINE & SPORTS CARE PLLC
Location Address4309 W 27TH PL STE 202Kennewick, WA 99338-2908
Mailing Address4309 W 27th Pl Ste 202Kennewick, WA 99338-2908
Phone(509) 591-4966
Organization SubpartNo
Authorized OfficialJohn GronerOwner / Md · (509) 591-4966
Enumeration DateMay 6, 2021
NPPES CertifiedMay 6, 2021
✔ NPI 1407430317 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical Medicine & Rehabilitation · Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2081P2900X
Definition
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.
4309 W 27TH PL STE 202, Kennewick, WA 99338
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Other Identifiers 1

OtherMD00049437WA · Wa License

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska.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 Spine & Sports Care Pllc 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 Revitalize Spine & Sports Care PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

John Groner, MD
Physical Medicine and Rehabilitation
NPI 1184787491
4309 W 27TH PL STE 202
Kennewick, WA 99338
(509) 591-4966
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently 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 Spine & Sports Care PLLC's NPI number?

The NPI number for Revitalize Spine & Sports Care PLLC is 1407430317. It was assigned to this organization in the NPPES registry on May 6, 2021.

Where is Revitalize Spine & Sports Care PLLC located?

Revitalize Spine & Sports Care PLLC is located at 4309 W 27th Pl Ste 202, Kennewick, WA 99338. The listed phone number is (509) 591-4966.

What is Revitalize Spine & Sports Care PLLC's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation, specializing in Pain Medicine, with taxonomy code 2081P2900X.

Is Revitalize Spine & Sports Care PLLC enrolled in Medicare?

Yes. Revitalize Spine & Sports Care PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Revitalize Spine & Sports Care PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Medicine and Rehabilitation) reassigns their Medicare billing to Revitalize Spine & Sports Care PLLC. 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.

What insurance does Revitalize Spine & Sports Care PLLC accept?

Health plans from Premera Blue Cross Blue Shield of Alaska list Revitalize Spine & Sports Care PLLC 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 Spine & Sports Care PLLC was last updated on May 6, 2021. 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.