REVITALIZE MEDICAL CENTER LLC – Interventional Pain Medicine Physician, NPI 1467934414
Interventional Pain Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for REVITALIZE MEDICAL CENTER LLC
355 Ridge Ave
Evanston, IL 602023328
Phone: (847) 834-4018
Type: Location
Orchard Lane, Northfield, New Trier Township, Cook County, Illinois, 60093, United States
NORTHFIELD, IL 60093
Phone: (847) 834-4018
Fax: (847) 834-4944
Type: Mailing
Austin Street, Evanston, Evanston Township, Cook County, Illinois, 60202, United States
EVANSTON, IL 602023455
Phone: (847) 328-4451
Type: Location
2550 COMPASS RD UNIT AB
GLENVIEW, IL 600261610
Phone: (847) 834-4018
Fax: (847) 834-4944
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-11-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-11-30 (922 days ago).
Enrollment records
1
Earliest due date
2023-11-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20181116001667 | O | Clinic/Group Practice | IL | 2023-11-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60202)
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