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JOSE FELIX REVOLLO
NPI 1013553502
Nurse Practitioner - Psychiatric/Mental Health in Fort Washington, MD

Active since November 20, 2019PECOS Enrolled
703 CLAMOR CT, FORT WASHINGTON, MD 20744(201) 757-4005 Get Directions Write a Review

NPPES record last updated: July 8, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 8, 2026, Jun 4, 2026, Nov 20, 2019 (3 updates tracked since 2019).

About Jose Felix Revollo NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOSE FELIX REVOLLO (NPI 1013553502) is an individual psychiatric/mental health provider in Fort Washington, Maryland, licensed in Maryland (R239041) and active in the NPI registry since November 2019. He is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1013553502
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameJOSE FELIX REVOLLO
Location Address703 CLAMOR CTFort Washington, MD 20744-5170
Mailing Address703 Clamor CtFort Washington, MD 20744-5170 · (201) 757-4005
Phone(201) 757-4005
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateNovember 20, 2019
Last NPPES UpdateJuly 8, 20263 updates tracked since enumeration
NPPES CertifiedJuly 8, 2026
✔ NPI 1013553502 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in MD · R239041
Also ListedRegistered NurseTaxonomy 163W00000X · License R239041 (MD)
703 CLAMOR CT, Fort Washington, MD 20744
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jose Felix Revollo is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID345700894
PECOS Enrollment IDI20260903000903
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jose Revollo reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Innovative Treatment Centers
35 mi
Mental Health (Including Community Mental Health Center)
325 HOSPITAL DR STE 106
Glen Burnie, MD 21061
  • Reassigned Medicare billing, Maryland enrollment
  • 9 clinicians in this Medicare group
NPI 1568175867 (443) 430-2998

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20744 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$113.72 typical visit price
range $21.40 – $158.88
Typical copayment $28.43 (range $5.35 – $39.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jose Revollo's NPI number?

The NPI number for Jose Revollo is 1013553502. It was assigned to this individual provider in the NPPES registry on November 20, 2019.

Where is Jose Revollo located?

Jose Revollo practices at 703 Clamor Ct, Fort Washington, MD 20744. The listed phone number is (201) 757-4005.

What is Jose Revollo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jose Revollo enrolled in Medicare?

Yes. Jose Revollo is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jose Revollo's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jose Revollo reassigns Medicare benefits to Innovative Treatment Centers (Glen Burnie, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jose Revollo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jose Revollo was last updated on July 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.