NPIMap

Organization Active NPI

Modern Pain & Spine PC

  • Interventional Pain Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1821695081
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
MODERN PAIN & SPINE PC
Practice address
1540 Juan Tabo Blvd NE Ste a
Albuquerque, NM 87112-4460
Phone
(505) 529-8511
NPI assigned
Oct 1, 2020
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Authorized official

Name
Dr. Athanasios Kostandinos Manole, MDNPI 1780002220
Title
Medical Director
Phone
(505) 529-8511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X
Occupational Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083X0100X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

1540 Juan Tabo Blvd NE Ste a
Albuquerque, NM 87112-4460

Mailing address

1540 Juan Tabo Blvd NE Ste a
Albuquerque, NM 87112-4460
Phone (595) 519-8511

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201123000966 NM Part B Supplier - Clinic/Group Practice 7911318068 Receives reassigned benefits from 6 practitioners
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory

Locations

1540 Juan Tabo Blvd NE
Ste A
Albuquerque, NM 87112
Phone (505) 319-0231

2500 Louisiana Blvd NE
Ste 101
Albuquerque, NM 87110
Phone (505) 800-7246

2500 Louisiana Blvd NE
Ste 300
Albuquerque, NM 87110

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1821695081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 JUAN TABO BLVD NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871124460",
            "telephone_number": "595-519-8511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 JUAN TABO BLVD NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871124460",
            "telephone_number": "505-529-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN PAIN & SPINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "MANOLE",
        "authorized_official_first_name": "ATHANASIOS",
        "authorized_official_middle_name": "KOSTANDINOS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "505-529-8511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.