Jennifer Alicea Revoredo, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

25MP00304400 Issued in NJ

Practice address

20 Valley St Ste 320
South Orange, NJ 07079-2881

Phone

(973) 313-1113

NPI assigned

Apr 15, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Emergency Physician Associates of North Jersey P C

  • Emergency Medicine Physician
  • Summit, NJ
  • NPI 1497783419
  Medicare reassignment
• Emergency Physician Services of New Jersey,Professional Association

  • Emergency Medicine Physician
  • Mount Holly, NJ
  • NPI 1831539568
  Medicare reassignment
• Faster Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Morris Plains, NJ
  • NPI 1326291253
  Medicare reassignment
• Goldson Medical Associates, LLC

  • Internal Medicine Physician
  • South Orange, NJ
  • NPI 1184668485
  Medicare reassignment

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

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488844800000",
    "number": "1801239363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 VALLEY ST STE 320",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792881",
            "telephone_number": "973-313-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 VALLEY ST STE 320",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792881",
            "telephone_number": "973-313-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVOREDO",
        "first_name": "JENNIFER",
        "middle_name": "ALICEA",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-15",
        "last_updated": "2017-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NJ",
            "license": "25MP00304400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philippe Quipot
• Darren Rafel
• Rebecca Randall, LPC
• Raymond Wade Ransom, ATC, PTA
• Regional Cardiology Consultants, PC
• Shantella Rios
• Artrice Catrina Ritchwood, APN
• Roanoke Psychological Services Inc
• Annaphene Elizabeth Roberson
• Robert Massa, DMD, PA

• Medical Physician Assistant in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Medical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.