Bruce A Mortensen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2000 S Thompson St
Flagstaff, AZ 86001-8759

Phone

(928) 226-6400

Fax

(928) 226-6410

NPI assigned

Dec 22, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bmortensen706406@direct.novanthealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• American Current Care of Arizona PA

  dba Concentra Urgent Care

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1780873307
  Medicare reassignment NPD
• Bull City Physicians, PLLC

  • Emergency Medicine Physician
  • Henderson, NC
  • NPI 1770004285
  Medicare reassignment
• The Carolinas Emergency Group, PLLC

  • Emergency Medicine Physician
  • Dunn, NC
  • NPI 1477508836
  Medicare reassignment

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1013305283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 E ROUTE 66 STE 100",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860014772",
            "telephone_number": "928-773-9695",
            "fax_number": "928-773-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S THOMPSON ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860018759",
            "telephone_number": "928-226-6400",
            "fax_number": "928-226-6410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1713 S Church St",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "NC",
            "postal_code": "272155630",
            "country_code": "US",
            "telephone_number": "336-222-8888",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "794 S Main St Ste B",
            "address_purpose": "LOCATION",
            "city": "Kernersville",
            "state": "NC",
            "postal_code": "272844074",
            "country_code": "US",
            "telephone_number": "336-996-2173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "BRUCE",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-22",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bmortensen706406@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1713 S Church St",
            "city": "Burlington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272155630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brent Gregory Morrow, DPT
• Cori Morse, NNP-BC
• Jill Venna Morse
• Mortar and Pestle (Mortar & Pestle)
• Mortar and Pestle Compounding Pharmacy
• Michael Mortensen, DO
• Moseng Chiropractic, P.C.
• Nathan Alan Moss, AGACNP-BC
• John Michael Motl, M.D.
• Shokofeh Motlagh, DMD

• Physician Assistant in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.