Active NPI
Jackson Charles Paine
- Case Manager/Care Coordinator
- Albuquerque, NM
National Provider Identifier
1174432355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1317 Isleta Blvd SW
Albuquerque, NM 87105-4035 - Phone
- (505) 312-7296
- Fax
- (505) 212-5975
- NPI assigned
- Sep 3, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
1317 Isleta Blvd SW
Albuquerque, NM 87105-4035
Mailing address
835 Fitzgerald Rd NW
Albuquerque, NM 87107-2437
Phone (505) 312-7296
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788393600000",
"number": "1174432355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 FITZGERALD RD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871072437",
"telephone_number": "505-312-7296",
"fax_number": "505-212-5975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1317 ISLETA BLVD SW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871054035",
"telephone_number": "505-312-7296",
"fax_number": "505-212-5975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAINE",
"first_name": "JACKSON",
"middle_name": "CHARLES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-09-03",
"last_updated": "2026-09-03",
"certification_date": "2026-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.