Individual provider Active NPI

Manuel Brandon Pacheco IV, MPAS, PA-C

  • Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1053969477
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2019-0076 Issued in NM
Practice address
6400 Paseo del Norte NE
Albuquerque, NM 87113-1718
Phone
(505) 596-2100
NPI assigned
Aug 28, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2019-0076 NM Primary

Addresses

Primary practice location

6400 Paseo del Norte NE
Albuquerque, NM 87113-1718

Mailing address

PO Box 5122
Bernalillo, NM 87004-5122
Phone (505) 280-5336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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

Enrollment IDStateProvider typePAC IDDetails
I20191030003164 NM Practitioner - Physician Assistant 7416289053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

3630 Las Estancias Dr SW
Albuquerque, NM 87121-5504
Phone (505) 462-7777

3901 Atrisco Dr NW
Albuquerque, NM 87120-1627
Phone (505) 462-7575

4100 High Resort Blvd SE
Rio Rancho, NM 87124-5901
Phone (505) 462-8888

609 S Christopher Rd
Belen, NM 87002-2615
Phone (505) 864-5454

8300 Constitution Ave NE
Albuquerque, NM 87110-7613

PO Box
Albuquerque, NM 87125-6666

Hospital & facility affiliations

  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2019-0076NMMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Nov 18, 2019 Accepting new patients
Presbyterian Healthcare Services CurrentSince Nov 18, 2019 Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients

Locations

5901 Harper Dr NE
Albuquerque, NM 87109
Phone (505) 823-8233

3630 Las Estancias Dr SW
Albuquerque, NM 87121
Phone (505) 462-7777

4588 Paradise Blvd NW
Albuquerque, NM 87114
Phone (505) 923-2070

8300 Constitution Ave NE
Bldg D
Albuquerque, NM 87110
Phone (505) 291-2200

3901 Atrisco Dr NW
Albuquerque, NM 87120
Phone (505) 462-7575

6400 Paseo del Norte NE
Albuquerque, NM 87113
Phone (505) 596-2100

609 Christopher Dr
Belen, NM 87002
Phone (505) 861-1771

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

4100 High Resort Blvd SE
Rio Rancho, NM 87124
Phone (505) 291-2770

Interoperability endpoints

  • Direct secure messaging: mpacheco88915@direct.phs.org

Organizations & group practices 3

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 2

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": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1053969477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5122",
            "city": "BERNALILLO",
            "state": "NM",
            "postal_code": "870045122",
            "telephone_number": "505-280-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 PASEO DEL NORTE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131718",
            "telephone_number": "505-596-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "MANUEL",
        "middle_name": "BRANDON",
        "name_suffix": "IV",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2019-0076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.