Jacqueline Otake, in Albuquerque, NM - Medicare Certified Registered Nurse Anesthetist (crna)

Jacqueline Otake, is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Albuquerque, New Mexico. She graduated from nursing school in 2024 and has 1 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice St Alphonsus Professional Medical Services Llc and her current practice location is 1100 Central Ave Se, Albuquerque, New Mexico. You can reach out to her office (for appointments etc.) via phone at (505) 841-1234.

Jacqueline Otake is licensed to practice in New Mexico (license number 80042) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1720769763.

Contact Information

	Jacqueline Otake,
	1100 Central Ave Se, Albuquerque, NM 87106-4930
	(505) 841-1234
	Not Available

Map and Direction

Provider's Profile

Full Name	Jacqueline Otake
Gender	Female
Speciality	Certified Registered Nurse Anesthetist (crna)
Experience	1 Years
Location	1100 Central Ave Se, Albuquerque, New Mexico
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Jacqueline Otake graduated from nursing school in 2024

NPI Data:

NPI Number: 1720769763
Provider Enumeration Date: 07/31/2023
Last Update Date: 07/02/2025

Medicare PECOS Information:

PECOS PAC ID: 1759813421
Enrollment ID: I20250514002293

Medical Identifiers

Medical identifiers for Jacqueline Otake such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1720769763	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	80042 (New Mexico)	Primary
367500000X	Nurse Anesthetist, Certified Registered	114672-23 (New Hampshire)	Secondary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Saint Alphonsus Regional Medical Center	Boise, ID	Hospital
Presbyterian Hospital	Albuquerque, NM	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
St Alphonsus Professional Medical Services Llc	7214849751	106

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacqueline Otake allows following entities to bill medicare on her behalf.

Entity Name	St Alphonsus Professional Medical Services Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1386677524 PECOS PAC ID: 7214849751 Enrollment ID: O20040205001184

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacqueline Otake is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jacqueline Otake, 8770 Washington Blvd Apt 420, Culver City, CA 90232-2482 Ph: (860) 519-6073	Jacqueline Otake, 1100 Central Ave Se, Albuquerque, NM 87106-4930 Ph: (505) 841-1234

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Albuquerque, NM

Francis Joseph Stoecker Iii, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1313 Dakota St Se, Albuquerque, NM 87108 Phone: 719-351-7921
Kyle Rodgers, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 6709 Academy Rd Ne Ste A, Albuquerque, NM 87109 Phone: 505-308-3145
Mr. J D Sharick, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2211 Lomas Blvd Ne, Albuquerque, NM 87106 Phone: 505-272-3119
Hideyo Tsumura, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4401 Masthead St Ne Ste 120, Albuquerque, NM 87109 Phone: 505-243-7729 Fax: 505-243-4804
Mr. Michael Bailey, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 7788 Jefferson St Ne, Albuquerque, NM 87109 Phone: 505-999-1600 Fax: 505-999-1650
David Timmons, DNP, APRN, CRNA, RN Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1100 Central Ave Se, Albuquerque, NM 87106 Phone: 505-841-1234
David Vincent Dick, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1100 Central Ave Se, Albuquerque, NM 87106 Phone: 505-841-1234 Fax: 505-841-1956

Jacqueline Otake, - Medicare Certified Registered Nurse Anesthetist (crna) in Albuquerque, NM