JEROME WAYNE BACA (NPI# 1811243462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811243462 |
| Entity Type | Individual |
| Full Name | JEROME WAYNE BACA |
| Credential | PA-C |
| Practice Address |
6701 Jefferson St Ne Albuquerque NM 87109 |
| Mailing Address |
6701 Jefferson St Ne Albuquerque NM 87109-4318 |
| Practice Telephone | 5057276200 |
| Practice Fax Number | 5057279590 |
| Mailing Telephone | 5057276200 |
| Mailing Fax Number | 5057279590 |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2019-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA2012-0025 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | NM MEDICAL LICENSE | PA2012-0025 | 01 |
| NM | 64471870 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 610 Broadway Blvd Ne, Albuquerque, NM 871022372 | 5052423991 | 5052438405 |
| Street Address |
6701 JEFFERSON ST NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780676262 | Karla Kay Giese | Internal Medicine | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2005-08-19 |
| 1528559796 | Nicole Knowlton Nunez | Nurse Practitioner | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2018-05-23 |
| 1922506294 | Mohammad S Islam | Physician Assistant | 6701 Jefferson St Ne, Albuquerque, NM 87109 | 2018-01-31 |
| 1215461009 | Kelsea Buettner | Nurse Practitioner | 6701 Jefferson St Ne, Albuquerque, NM 87109 | 2017-04-18 |
| 1639598972 | Tomy Yojan Perez | Urology | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2014-04-15 |
| 1669819322 | Andrew W Clarkinson | Family Medicine | 6701 Jefferson St Ne, Albuquerque, NM 87109 | 2013-06-03 |
| 1417295916 | Teresa J Anderson | Dietitian, Registered | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2013-01-18 |
| 1689924698 | Leslie Nicole Heggen | Physician Assistant | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2012-09-17 |
| 1508142050 | Lisa Khalil Ereifej | Internal Medicine | 6701 Jefferson St Ne, Albuquerque, NM 87109 | 2011-10-28 |
| 1700189479 | Lucus William Enslin | Nurse Practitioner | 6701 Jefferson St Ne, Albuquerque, NM 87109-4318 | 2010-12-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
| 1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
| 1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
| 1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
| 1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
| 1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
| 1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
| 1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
| 1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
| 1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
| Find all providers in zip 87109 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386284602 | Christopher Whorley | Physician Assistant | 4683 Idlewilde Ln Se, Albuquerque, NM 87108-3421 | 2020-01-15 |
| 1053836809 | Alysha Gallegos | Physician Assistant | 6112 Molinero Ct Sw, Albuquerque, NM 87105-6814 | 2017-08-13 |
| 1306225180 | Allison Rose Crossey | Physician Assistant | 201 Cedar Street Se, Suite 6600, Albuquerque, NM 87106 | 2015-05-26 |
| 1336543115 | Pamela O Black Md, P.a., Dba Quadra Health Institute | Physician Assistant | 3820 Commons Ave Ne # M, Albuquerque, NM 87109-5831 | 2014-10-22 |
| 1457686511 | Bayle R. Curtis | Physician Assistant | 1806 Morningrise Pl Se, Albuquerque, NM 87108-4520 | 2009-10-07 |
| 1215173919 | Amber Dawn Hansen | Physician Assistant | 1100 Cenrral Ave Se, Albuquerque, NM 87106 | 2008-12-30 |
| 1508028606 | Angela Genette Baumeister | Physician Assistant | 707 13th St Nw, Albuquerque, NM 87102-1841 | 2008-06-30 |
| 1528230117 | Laura Wylie | Physician Assistant | 1101 Medical Arts Ave Ne # 4, Building 4, Suite A, Unm Senior Health, Albuquerque, NM 87102-2706 | 2008-03-24 |
| 1457406951 | Deneen Tomayko | Physician Assistant | 2211 Lomas Blvd Ne Fl 4, Albuquerque, NM 87106-2745 | 2007-01-24 |
| 1083793665 | Karen Kay Nester | Physician Assistant | 4901 Lang Ave, Ne, Suite 100, Albuquerque, NM 87109-4597 | 2006-11-03 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87109 |
Please comment or provide details below to improve the information on JEROME WAYNE BACA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.