Revival Health and Wellness Clinic
NPI 1366241507ActiveOrganization· Family Medicine· Salem, IL
Family Medicine in Salem, Illinois, registered in NPPES in March 2025. The authorized official on file is Crea Rose, NP, Owner/ Provider. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1366241507 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 11, 2025 |
| Last updated in NPPES | Jun 27, 2025 |
| Certified by provider | Jun 27, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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