Active NPI
Peter David Pacheco, RPH., PA-C
- Physician Assistant
- Albuquerque, NM
National Provider Identifier
1760471395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2001PA02
- Practice address
- 4700 Jefferson St NE
Suite 700
Albuquerque, NM 87109-2136 - Phone
- (505) 881-5080
- Fax
- (505) 872-2306
- NPI assigned
- Oct 17, 2005
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2001PA02 | NM | Primary |
Addresses
Primary practice location
4700 Jefferson St NE
Suite 700
Albuquerque, NM 87109-2136
Mailing address
15 Calle Alfredo
Algodones, NM 87001-8025
Phone (505) 235-8031
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3500 Comanche Rd NE
BLDG G
Albuquerque, NM 87107-4546
Phone (505) 881-5080
4700 Jefferson St NE
Suite 700
Albuquerque, NM 87109-2132
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001PA02 | NM | MD | Physician Assistant |
Organizations & group practices 1
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.
-
- Pain Medicine (Anesthesiology) Physician
- Albuquerque, NM
- NPI 1932411220
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358812800000",
"number": "1760471395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 CALLE ALFREDO",
"city": "ALGODONES",
"state": "NM",
"postal_code": "870018025",
"telephone_number": "505-235-8031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 JEFFERSON ST NE",
"address_2": "SUITE 700",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871092136",
"telephone_number": "505-881-5080",
"fax_number": "505-872-2306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACHECO",
"first_name": "PETER",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "RPH., PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2013-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "2001PA02",
"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 Jan 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.