Revamp - Encardia, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

REVAMP - ENCARDIA, LLC

Doing business as

ReVaMP Heart & Vascular Surgery Center

Practice address

510 N Broad St Ste 201
Philadelphia, PA 19130-4379

Phone

(267) 908-9520

NPI assigned

Jun 17, 2024

Organization subpart

No

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

Authorized official

Name

Jennifer Boyd Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5954

Specialties & licenses 1

Addresses

Other names 1

• ReVaMP Heart & Vascular Surgery Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962245076. Details of each certification follow.

• CCN 39C0001400 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 39C0001400

Legal name

ReVaMP Heart & Vascular Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 8, 2025

Last certification

Oct 8, 2025

Facility address

510 North Broad Street Suite 201
Philadelphia, PA 19130

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1962245076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 N BROAD ST STE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191304379",
            "telephone_number": "267-908-9520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 N BROAD ST STE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191304379",
            "telephone_number": "267-908-9520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVAMP - ENCARDIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-17",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReVaMP Heart & Vascular Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer L Reuter
• Courtney R. Reuther, MS.OTR/L
• Kristan Reutlinger
• Rachael Reuvani
• Sarah Revak, MD
• Dominique Faye Revan, MD
• Revascmedprofessionals PC (ReVamp)
• Jessica Revell, LCSW
• Revere Dental PC (Revere Dental)
• Karen Elizabeth Revere, M.D.

• Ambulatory Surgical Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.