Mr Jack Colt Blaine, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Albuquerque, NM

Mr Jack Colt Blaine, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Albuquerque, New Mexico. He graduated from nursing school in 1989 and has 35 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Yuma Regional Medical Center and his current practice location is 6709 Academy Rd Ne Ste A, Albuquerque, New Mexico. You can reach out to his office (for appointments etc.) via phone at (505) 312-4712.

Mr Jack Colt Blaine is licensed to practice in New Mexico (license number CRNA00868) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1811999642.

Contact Information

Mr Jack Colt Blaine, CRNA
6709 Academy Rd Ne Ste A,
Albuquerque, NM 87109-3363
(505) 312-4712
Not Available



Provider's Profile

Full NameMr Jack Colt Blaine
GenderMale
SpecialityCertified Registered Nurse Anesthetist (crna)
Experience35 Years
Location6709 Academy Rd Ne Ste A, Albuquerque, New Mexico
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Mr Jack Colt Blaine graduated from nursing school in 1989
  NPI Data:
  • NPI Number: 1811999642
  • Provider Enumeration Date: 08/11/2005
  • Last Update Date: 01/19/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 6800831579
  • Enrollment ID: I20070911000418

Medical Identifiers

Medical identifiers for Mr Jack Colt Blaine such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1811999642NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered CRNA0061 (Arizona)Secondary
367500000XNurse Anesthetist, Certified Registered AP108435 (Texas)Secondary
367500000XNurse Anesthetist, Certified Registered NA1771 (California)Secondary
367500000XNurse Anesthetist, Certified Registered CRNA00868 (New Mexico)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Yuma Regional Medical CenterYuma, AZHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Yuma Regional Medical Center2062314826288

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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. Mr Jack Colt Blaine allows following entities to bill medicare on his behalf.
Entity NameYuma Regional Medical Center
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1194706655
PECOS PAC ID: 2062314826
Enrollment ID: O20040122000526

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Entity NameClinical Colleagues Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1366958274
PECOS PAC ID: 8729011333
Enrollment ID: O20180222002396

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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. Mr Jack Colt Blaine 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 AddressPractice Location Address
Mr Jack Colt Blaine, CRNA
36720 Palm Ct,
Rancho Mirage, CA 92270-2206

Ph: (619) 994-2941
Mr Jack Colt Blaine, CRNA
6709 Academy Rd Ne Ste A,
Albuquerque, NM 87109-3363

Ph: (505) 312-4712

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Nurse Anesthetist, Certified Registered Nurses in Albuquerque, NM

Francis Joseph Stoecker Iii, CRNA
Nurse Anesthetist - CR
Medicare: Medicare Enrolled
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 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
Morgan J Ouellette Morrow, 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

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