Revitalize Ketamine Clinic LLC
NPI 1346911195 · Multi-Specialty Clinic/Center · Flagstaff, AZ
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Revitalize Ketamine Clinic LLC is a Multi-Specialty Clinic/Center organization in Flagstaff, AZ (NPI 1346911195).
Provider details
- NPI number
- 1346911195
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jill Dubravcic, Owner/Operator(928) 213-6931
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Other name
- Revketa
Registry dates
- Enumerated
- 2021-09-22
- Last updated
- 2021-09-22
- Certified
- 2021-07-13
Frequently asked questions
- What is Revitalize Ketamine Clinic LLC's NPI number?
- Revitalize Ketamine Clinic LLC's National Provider Identifier (NPI) is 1346911195, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Revitalize Ketamine Clinic LLC?
- Revitalize Ketamine Clinic LLC is classified in the NPPES registry as Multi-Specialty Clinic/Center (Ambulatory Health Care Facilities).
- Where is Revitalize Ketamine Clinic LLC located?
- Revitalize Ketamine Clinic LLC's practice location on file with NPPES is 1800 S Milton Rd Ste 26, Flagstaff, AZ 86001-6340.
- What is Revitalize Ketamine Clinic LLC's phone number?
- The practice phone number listed in the NPPES registry for Revitalize Ketamine Clinic LLC is (928) 213-6931.
- Does Revitalize Ketamine Clinic LLC accept Medicare?
- Revitalize Ketamine Clinic LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Revitalize Ketamine Clinic LLC?
- The authorized official listed on Revitalize Ketamine Clinic LLC's NPPES record is Jill Dubravcic, Owner/Operator. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Revitalize Ketamine Clinic LLC's NPI active?
- Yes — Revitalize Ketamine Clinic LLC's NPI (1346911195) is active in the NPPES registry as of the last update on 2021-09-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.