Individual provider Active NPI

Jonathan W Revels, DO

  • Diagnostic Radiology Physician
  • Albuquerque, NM
National Provider Identifier
1750674164
Registry record updated Feb 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
OP60730003 Issued in WA
Practice address
2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone
(505) 272-1476
NPI assigned
May 17, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A-2207-19 NM
Diagnostic Radiology Physician 2085R0202X OP60730003 WA Primary

Addresses

Primary practice location

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719

Mailing address

PO Box 50095
Seattle, WA 98145-5095
Phone (206) 520-5700

Other practice location 1

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-7200

Other practice location 2

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-7200

Other identifiers 1

IdentifierTypeStateIssuer
1750674164MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, NY, FL3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20190227000229 NM Practitioner - Diagnostic Radiology 4486956083 Reassigns benefits to 2 organizations
I20220222001923 NY Practitioner - Diagnostic Radiology 4486956083 Reassigns benefits to 2 organizations
I20230731001394 FL Practitioner - Diagnostic Radiology 4486956083 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Touro Un College of Osteopathic Medicine, Vallejo, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

1300 Ave P
Brooklyn, NY 11229-1106
Phone (718) 376-1004

13303 Jamaica Ave
Jamaica, NY 11418-2618
Phone (718) 206-6923

1530 Front St
East Meadow, NY 11554-2265
Phone (516) 324-7500

159 E 53Rd St
New York, NY 10022-4602
Phone (646) 754-3300

160 E 34TH St
New York, NY 10016-4744
Phone (212) 263-7300

16244 S Military TRL
560 NYU Langone Cardiology Delray Bea
Delray Beach, FL 33484-6532
Phone (561) 495-7787

180 E Pulaski Rd
Huntington Station, NY 11746-1915
Phone (516) 747-8900

2318 31St St
Suite 200
Astoria, NY 11105-2765
Phone (718) 777-7742

259 1St St
Mineola, NY 11501-3957
Phone (516) 222-8600

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

6915 Austin St
Forest Hills, NY 11375-4255
Phone (718) 544-5100

74 Kent St
Brooklyn, NY 11222-1517
Phone (516) 365-4949

9400 Bear Mountain TRL NE
Albuquerque, NM 87113-1335
Phone (212) 263-5230

9785 Queens Blvd
Rego Park, NY 11374-3319
Phone (718) 261-9100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Unm Medical Group, Inc. CurrentSince Feb 1, 2019 Accepting new patients
Unm Medical Group Inc CurrentSince Feb 1, 2019 Accepting new patients
New York University CurrentSince Jan 1, 2022 Accepting new patients
New York University CurrentSince Jan 1, 2022 Accepting new patients

Locations

933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jrevels4164560@nychhc.direct-ci.com
  • Direct secure messaging: jrevels487624@nyumc.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1750674164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-520-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 LOMAS BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062719",
            "telephone_number": "505-272-1476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 NE Pacific St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98195",
            "country_code": "US",
            "telephone_number": "206-598-7200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1959 NE Pacific St",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98195",
            "country_code": "US",
            "telephone_number": "206-598-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REVELS",
        "first_name": "JONATHAN",
        "middle_name": "W",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-17",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NM",
            "license": "A-2207-19",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WA",
            "license": "OP60730003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750674164",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.