OrganizationActive
Revive Ketamine and Wellness PC
NPI 1841146214 · Health Service Clinic/Center · Lafayette, IN
Provider details
- NPI number
- 1841146214
- Entity type
- Organization
- Primary specialty
- Health Service Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Nicholas Sansone, Dr(773) 208-5872
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in 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
210 Meijer Dr Ste C
Lafayette, IN 47905-4694
Phone: (765) 764-9305
Street-level locationGet directions
Mailing address
3040 Lake Shore Dr
Michigan City, IN 46360-1708
Registry dates
- Enumerated
- 2026-03-09
- Last updated
- 2026-03-09
- Certified
- 2026-03-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.