Fred Revoredo (NPI# 1669588422, PAC ID# 3779479480) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL PRACTICE.
| Nation Provider ID (NPI) | 1669588422 |
| PAC ID by PECOS | 3779479480 |
| Professional Enrollment ID | I20040227000314 |
| Full Name | Fred Revoredo |
| Address |
425 15th Ave Suite 2 Paterson NJ 07504-1811 |
| Gender | M |
| Credential | MD |
| Graduation Year | 1995 |
| Primary Specialty | GENERAL PRACTICE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 310019 | ST JOSEPH'S HOSPITAL AND MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 49 Forest Rd, Monroe, NY 10950-2923 | 8457823242 | EZRAS CHOILIM HEALTH CENTER INC |
| 425 15th Ave, Suite 2, Paterson, NJ 07504-1811 |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_1 | Immunization Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_238_2+ | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 30% | |
| MIPS_EC_238_overall | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 49% |
| Street Address |
425 15TH AVE SUITE 2 |
| City | PATERSON |
| State | NJ |
| Zip | 07504-1811 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Scott A Goler | Podiatry | Sovereign Medical Group LLC | 265 E 33rd St, Paterson, NJ 07504-1668 |
| Daniel J Waltuch | Podiatry | Sovereign Medical Group LLC | 265 E 33rd St, Paterson, NJ 07504-1668 |
| Alvaro Tellez | Internal Medicine | 466 Park Ave, Paterson, NJ 07504-1806 | |
| Pudchong Srisethnil | Internal Medicine | 561 E 28th St, Paterson, NJ 07504-1862 | |
| Nidia Ortega | Family Medicine | Centro Medico Iberoamericano Inc. | 416 Park Ave, Paterson, NJ 07504-1930 |
| Melissa Amy Desueza | Nurse Practitioner | Centro Medico Iberoamericano Inc. | 416 Park Ave, Paterson, NJ 07504-1930 |
| Ramon A Sandoval | Internal Medicine | Centro Medico Iberoamericano Inc. | 416 Park Ave, Paterson, NJ 07504-1930 |
| Juan A Desueza | Internal Medicine | Centro Medico Iberoamericano Inc. | 416 Park Ave, Paterson, NJ 07504-1930 |
| City | PATERSON |
| Zip Code | 07504 |
| Specialty | GENERAL PRACTICE |
| City + Specialty | PATERSON + GENERAL PRACTICE |
Please comment or provide details below to improve the information on Fred Revoredo.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.