REVITALIZED WELLNESS PLLC
NPI 1760093025
Clinic/Center - Primary Care in Sioux Falls, SD
About Revitalized Wellness Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVITALIZED WELLNESS PLLC (NPI 1760093025) is a healthcare organization registered as a primary care in Sioux Falls, South Dakota and active in the NPI registry since August 2020. The organization holds a CLIA Waiver certificate valid through May 25, 2028, maintains 3 additional practice locations, and lists Kristi Lynn Ross, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Secondary Practice Locations 3
Group Practice 1
Accepted Insurance
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)
Revitalized Wellness Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 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.
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Revitalized Wellness PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (4)
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 2
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 16D2344580
Revitalized Wellness PLLC · Red Oak, IACertificate of Waiver 38D2270000
Revitalized Wellness PLLC · Eugene, ORFrequently 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 Revitalized Wellness PLLC's NPI number?
The NPI number for Revitalized Wellness PLLC is 1760093025. It was assigned to this organization in the NPPES registry on August 11, 2020.
Where is Revitalized Wellness PLLC located?
Revitalized Wellness PLLC is located at 326 E 8th St Apt 206, Sioux Falls, SD 57103. The listed phone number is (605) 423-7557.
What is Revitalized Wellness PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Revitalized Wellness PLLC enrolled in Medicare?
Yes. Revitalized Wellness PLLC is registered in the Medicare PECOS enrollment system.
When is Revitalized Wellness PLLC'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 (South Dakota, Clinic/Group Practice) is due for revalidation by October 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 Revitalized Wellness PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Revitalized Wellness 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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Revitalized Wellness PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 16D2344580) is associated with this NPI, valid through May 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Revitalized Wellness PLLC accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, BridgeSpan Health Company and Moda Health Plan, Inc. and 1 other insurer list Revitalized Wellness 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 Revitalized Wellness PLLC was last updated on August 6, 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.
# Revitalized Wellness Pllc · NPI 1760093025
Primary Care organization in Sioux Falls, South Dakota. Organization record, active in the CMS NPPES registry since August 11, 2020.
## Identity
- **NPI:** 1760093025 (Entity type: Organization)
- **Enumerated:** August 11, 2020
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Kristi Ross, OWNER
## Practice location
- **Address:** 326 E 8TH ST APT 206, Sioux Falls, SD 57103-7038
- **Phone:** (605) 423-7557 · **Fax:** (605) 305-1175
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, South Dakota, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 4 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 6, 2026
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1760093025) · Data from the CMS NPPES public registry.