Jacqueline Otake

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1229584 Issued in TX

Practice address

1100 Central Ave SE
Albuquerque, NM 87106-4930

Phone

(505) 841-1234

NPI assigned

Jul 31, 2023

Reactivated

Aug 29, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NM, ID, NH, KY4 enrollments

Enrollment records 4

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Professional Anesthesia Services of Kentucky PLLCGroup PAC ID 0244590305, 351 clinicians

Anesthesia Care Group PCGroup PAC ID 5395646178, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Exeter Hospital Inc Hospital, Exeter, NH, CCN 300023
• Baptist Health Louisville Hospital, Louisville, KY, CCN 180130

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Anesthesia Care Group PC

  • Anesthesiology Physician
  • Manchester, NH
  • NPI 1629074224
  Medicare reassignment Care Compare group NPD
• Professional Anesthesia Services of Kentucky PLLC

  • Anesthesiology Physician
  • Louisville, KY
  • NPI 1992212807
  Medicare reassignment Care Compare group
• St Alphonsus Professional Medical Services LLC

  • Anesthesiology Physician
  • Boise, ID
  • NPI 1386677524
  Medicare reassignment NPD
• St Alphonsus Professional Medical Services LLC

  • Trauma Surgery Physician
  • Boise, ID
  • NPI 1336166883
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Healthcare System Inc.

  • General Acute Care Hospital
  • Louisville, KY
  • NPI 1265539498
  Care Compare affiliation
• Exeter Hospital Inc

  • General Acute Care Hospital
  • Exeter, NH
  • NPI 1437158433
  Care Compare affiliation

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1720769763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8770 WASHINGTON BLVD APT 420",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322482",
            "telephone_number": "860-519-6073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CENTRAL AVE SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064930",
            "telephone_number": "505-841-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12222 Merit Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752513294",
            "country_code": "US",
            "telephone_number": "972-715-5000",
            "fax_number": "972-715-9976",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Alumni Dr",
            "address_purpose": "LOCATION",
            "city": "Exeter",
            "state": "NH",
            "postal_code": "038332160",
            "country_code": "US",
            "telephone_number": "603-778-7311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTAKE",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "deactivation_date": "2024-08-26",
        "reactivation_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1229584",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "80042",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": "114672-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen M Ostrem, MSN, CNM, CFNP
• Frank X Osullivan, MD
• Osuna Medical Associates, PA
• Eseohe Osunbor
• Sue Ellen Ota, O.T.R.
• Otel PLLC
• Ernesto R Otero Lopez, MD
• Rebecca Anne Otero-Granger, PMHNP-BC
• Crystal Otero-Griffith, CNP
• Andrea Nicole Otero-Looney, MAC

• Certified Registered Nurse Anesthetist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Certified Registered Nurse Anesthetist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.