Timothy Jackson

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

872 S Camino del Pueblo
Bernalillo, NM 87004-5927

Phone

(505) 867-2383

Fax

(505) 867-7293

NPI assigned

Oct 25, 2006

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• La Buena Vida, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bernalillo, NM
  • NPI 1386676856
  NPD (past)
• Valle del Sol of New Mexico, LLC

  • Community/Behavioral Health Agency
  • Bernalillo, NM
  • NPI 1649610171
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073697017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 AVANTI ST SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871218665",
            "telephone_number": "505-565-1619",
            "fax_number": "505-565-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 S CAMINO DEL PUEBLO",
            "city": "BERNALILLO",
            "state": "NM",
            "postal_code": "870045927",
            "telephone_number": "505-867-2383",
            "fax_number": "505-867-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIMOTHY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Suzanne Hudson, MD
• Hyberbaric Wellness LLC
• Indian Health Service
• Inline Chiropractic Corporation
• Felipita Christina Jacks, CHW SP.2
• Elizabeth Jaramillo, PT
• Christine Elizabeth Johnson, PH.D.
• Hannah Marie Johnson, OD
• Laura Darlene Johnson, FNP
• Jacqueline M. Jones-Bernard

• Case Manager/Care Coordinator in Bernalillo, NM
• Providers in Bernalillo, NM by specialty
• Case Manager/Care Coordinator in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.