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REVIVAMED MEDICAL CORPORATION
NPI 1609061498
Internal Medicine in San Diego, CA

Active since September 13, 2007
711 4TH AVE, SUITE 200, SAN DIEGO, CA 92101(619) 232-3040(619) 232-3041 Get Directions Write a Review

NPPES record last updated: September 13, 2007. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Revivamed Medical Corporation NPPES

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

REVIVAMED MEDICAL CORPORATION (NPI 1609061498) is a healthcare organization registered as an internal medicine in San Diego, California and active in the NPI registry since September 2007. The organization lists Roya Kohani, President, as its authorized official.

NPPES Registry Identity

NPI1609061498
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameREVIVAMED MEDICAL CORPORATION
Location Address711 4TH AVE, SUITE 200San Diego, CA 92101-6970
Mailing Address711 4th Ave, Suite 200San Diego, CA 92101-6970 · (619) 232-3040 · Fax (619) 232-3041
Phone(619) 232-3040
Fax(619) 232-3041
Organization SubpartNo
Authorized OfficialRoya KohaniPresident · (619) 232-3040
Enumeration DateSeptember 13, 2007
✔ NPI 1609061498 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in CA · A64593
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedSurgery · Plastic and Reconstructive SurgeryTaxonomy 2086S0122X · License A50365 (CA)
711 4TH AVE, San Diego, CA 92101
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Revivamed Medical Corporation is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20111019000494Non-DME Part B · Clinic/Group PracticeDue dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Revivamed Medical Corporation, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kian Samimi, MD
Plastic and Reconstructive Surgery
NPI 1649213281
711 4TH AVE SUITE 200
San Diego, CA 92101
(619) 232-3040
✔ 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 Revivamed Medical Corporation's NPI number?

The NPI number for Revivamed Medical Corporation is 1609061498. It was assigned to this organization in the NPPES registry on September 13, 2007.

Where is Revivamed Medical Corporation located?

Revivamed Medical Corporation is located at 711 4th Ave Suite 200, San Diego, CA 92101. The listed phone number is (619) 232-3040.

What is Revivamed Medical Corporation's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Revivamed Medical Corporation enrolled in Medicare?

Yes. Revivamed Medical Corporation is registered in the Medicare PECOS enrollment system.

When is Revivamed Medical Corporation's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Revivamed Medical Corporation?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Plastic and Reconstructive Surgery) reassigns their Medicare billing to Revivamed Medical Corporation. 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.

When was this NPI record last updated?

The NPPES record for Revivamed Medical Corporation was last updated on September 13, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.