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REVIVE MEDICAL CENTER LLC
NPI 1740996636
Family Medicine in Haleyville, AL

Active since January 25, 2023CLIA 01D2277640 · Certificate of Compliance
1728 11TH AVE, HALEYVILLE, AL 35565(205) 485-7822(260) 399-4004 Get Directions Write a Review

NPPES record last updated: February 22, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 22, 2023, Feb 15, 2023, Jan 25, 2023 (3 updates tracked since 2023).

About Revive Medical Center Llc NPPES

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

REVIVE MEDICAL CENTER LLC (NPI 1740996636) is a healthcare organization registered as a family medicine in Haleyville, Alabama and active in the NPI registry since January 2023. The organization holds a CLIA Certificate of Compliance certificate valid through December 4, 2027 and lists Larry Jake Pickens, Owner/president, as its authorized official.

NPPES Registry Identity

NPI1740996636
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameREVIVE MEDICAL CENTER LLC
Location Address1728 11TH AVEHaleyville, AL 35565-1506
Mailing AddressPo Box 1016Haleyville, AL 35565-1016 · (205) 485-7822 · Fax (260) 399-4004
Phone(205) 485-7822
Fax(260) 399-4004
Organization SubpartNo
Authorized OfficialLarry Jake PickensOwner/president · (205) 485-7822
Enumeration DateJanuary 25, 2023
Last NPPES UpdateFebruary 22, 20233 updates tracked since enumeration
NPPES CertifiedFebruary 22, 2023
✔ NPI 1740996636 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedClinic/Center · Urgent CareTaxonomy 261QU0200X
1728 11TH AVE, Haleyville, AL 35565
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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 Medical Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Revive Medical Center LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Amber Farris
Nurse Practitioner
NPI 1396561957
1728 11TH AVE
Haleyville, AL 35565
(205) 485-7822
✔ PECOS✔ Accepts MedicareSame address
Jake Pickens, CRNP
Nurse Practitioner
NPI 1770351769
1728 11TH AVE
Haleyville, AL 35565
(205) 485-7822
✔ PECOS✔ Accepts MedicareSame address
Amy Traylor, MD
Family Practice
NPI 1972000149
42030 HIGHWAY 195 STE A
Haleyville, AL 35565
(205) 485-7227
✔ PECOS✔ Accepts Medicare2.1 mi
Dillon Tate, NURSE PRACTITIONER
Nurse Practitioner
NPI 1730874249
2930 AL-237
Phil Campbell, AL 35581
(205) 993-5642
✔ PECOS✔ Accepts Medicare9.8 mi
Amanda Godsey, CRNP
Nurse Practitioner
NPI 1285878462
156 3RD AVE
Nauvoo, AL 35578
(205) 686-5113
✔ PECOS✔ Accepts Medicare18 mi
Chenyi Chenyi, MD
Family Practice
NPI 1922387299
15225 HIGHWAY 43 SUITE 1
Russellville, AL 35653
(256) 311-2700
✔ PECOS✔ Accepts Medicare21 mi
Rebeccca Stewart, CRNP-BC
Nurse Practitioner
NPI 1144047838
530 BEXAR AVE W
Hamilton, AL 35570
(205) 921-2838
✔ PECOS✔ Accepts Medicare22 mi
Sarah Mann, ARNP
Nurse Practitioner
NPI 1669981015
2548 US HIGHWAY 43
Winfield, AL 35594
(205) 395-5010
✔ PECOS✔ Accepts Medicare23 mi

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 Compliance 01D2277640

Revive Medical Center, LLC · Haleyville, AL
Active · expires Dec 4, 2027
CLIA Number01D2277640
Laboratory TypePhysician Office
Certificate Effective DateDecember 5, 2025
Certificate Expiration DateDecember 4, 2027
Laboratory DirectorDr. Chenyi Jeffrey Chenyi
Laboratory Phone(205) 485-7822
Laboratory LocationRevive Medical Center, LLC1728 11th Ave, Haleyville, AL 35565
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Patient Reviews User submitted

Reviews are submitted by site visitors and approved by a human moderator before publication.

Review by Scotty ***** March 30, 2025

5/5
Excellent care of their patients and timely treatments provided for your needs. All staff members are friendly and helpful with their attention focused on providing the best care possible.
Provider 5/5 Office Staff 5/5
Visited this provider? Share your experience.

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 Revive Medical Center LLC's NPI number?

The NPI number for Revive Medical Center LLC is 1740996636. It was assigned to this organization in the NPPES registry on January 25, 2023.

Where is Revive Medical Center LLC located?

Revive Medical Center LLC is located at 1728 11th Ave, Haleyville, AL 35565. The listed phone number is (205) 485-7822.

What is Revive Medical Center LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Revive Medical Center LLC enrolled in Medicare?

Yes. Revive Medical Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Revive Medical Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Revive Medical Center 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. The largest specialties are Nurse Practitioner (6) and Family Practice (2). Of these, 2 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Revive Medical Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 01D2277640) is associated with this NPI, valid through December 4, 2027. 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 Medical Center LLC was last updated on February 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.