Fred Revoredo, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA07147400 Issued in NJ

Practice address

425 15TH Ave
Paterson, NJ 07504-1811

Phone

(973) 345-4155

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ, NY2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

George Washington University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adoration Home Health Home health agency, Clifton, NJ, CCN 317017
• Visiting Health Services of New Jersey Home health agency, Woodland Park, NJ, CCN 317058

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FAJEDD/Endpoint/FAJEDD
• Direct secure messaging: fred.revoredo@echc.eclinicaldirectplus.com
• FHIR API: https://fhir4.healow.com/fhir/r4/FAJEDD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Premier Medical Care Plus LLC.

  • Family Medicine Physician
  • Fair Lawn, NJ
  • NPI 1205531688
  Medicare reassignment NPD Authorized official
• Aizer Health , Inc.

  • Federally Qualified Health Center (FQHC)
  • Monroe, NY
  • NPI 1063480218
  Medicare reassignment NPD
• Revoredo Medical Affiliates LLC

  • Family Medicine Physician
  • Paterson, NJ
  • NPI 1881927358

  Emergency Medicine

  NPD (past) Authorized official
• Elite Premier Medical Care LLC

  • Family Medicine Physician
  • Paterson, NJ
  • NPI 1609144005
  NPD
• Aizer Health , Inc.

  • Federally Qualified Health Center (FQHC)
  • Monroe, NY
  • NPI 1528941689
  NPD
• Hogarth Emergency Physicians

  • Emergency Medicine Physician
  • Newton, NJ
  • NPI 1770532343
  NPD (past)
• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Patient Care New Jersey, Inc.

  • Home Health Agency
  • Clifton, NJ
  • NPI 1013999382
  Care Compare affiliation
• Patient Care New Jersey, Inc.

  • Community Based Hospice Care Agency
  • Passaic, NJ
  • NPI 1144280017

  Home health agency

  Care Compare affiliation
• Vhsnj at Home, LLC

  • Home Health Agency
  • Woodland Park, NJ
  • NPI 1518407642
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1669588422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 15TH AVENUE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075041811",
            "telephone_number": "973-345-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 15TH AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075041811",
            "telephone_number": "973-345-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVOREDO",
        "first_name": "FRED",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8376808",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise Florian Renwick, CERTIFIED SOCIAL WOR
• Samantha Repekta, RDN
• Respiratory Associates Medical Products
• Jacqueline Rever, PHARMD
• Revoredo Medical Affiliates LLC
• Ana Maria Rexach
• Darianny Reyna
• Elizabeth Lila Reynolds, DO
• Augusto Reynoso, DPT
• Brittany Rezendes

• Family Medicine Physician in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.