REVIVE PATHWAY
NPI 1962117440
Clinic/Center - Rehabilitation, Substance Use Disorder in El Cajon, CA
About Revive Pathway NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVIVE PATHWAY (NPI 1962117440) is a healthcare organization registered as a rehabilitation, substance use disorder in El Cajon, California and active in the NPI registry since January 2023. The organization holds a CLIA Waiver certificate valid through August 7, 2027 and lists Judson Lea, Coo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
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 Pathway is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
18Medicare enrollment records show 18 clinicians reassign Medicare billing to Revive Pathway, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 6 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 7
Clinicians, nearest first (18)
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 05D2287034
Revive Pathway · El Cajon, CAFrequently 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 Pathway's NPI number?
The NPI number for Revive Pathway is 1962117440. It was assigned to this organization in the NPPES registry on January 18, 2023.
Where is Revive Pathway located?
Revive Pathway is located at 1240 Broadway, El Cajon, CA 92021. The listed phone number is (619) 841-1310.
What is Revive Pathway's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.
Is Revive Pathway enrolled in Medicare?
Yes. Revive Pathway is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revive Pathway?
According to the CMS Revalidation Reassignment List (October 2026 release), 18 clinicians in 7 Medicare specialties reassign their Medicare billing to Revive Pathway. 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), Family Practice (4) and Addiction Medicine (2). Of these, 5 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Revive Pathway hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2287034) is associated with this NPI, valid through August 7, 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 Pathway was last updated on May 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Revive Pathway · NPI 1962117440
Rehabilitation, Substance Use Disorder organization in El Cajon, California. Organization record, active in the CMS NPPES registry since January 18, 2023.
## Identity
- **NPI:** 1962117440 (Entity type: Organization)
- **Enumerated:** January 18, 2023
- **Primary specialty:** Clinic/Center - Rehabilitation, Substance Use Disorder · taxonomy 261QR0405X
- **Organization subpart:** No
- **Authorized official:** Judson Lea, COO
## Practice location
- **Address:** 1240 BROADWAY, El Cajon, CA 92021-4994
- **Phone:** (619) 841-1310
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 18 clinicians in 7 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (6), Family Practice (4), Addiction Medicine (2); 5 practice at this address and 6 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 6, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1962117440) · Data from the CMS NPPES public registry.