Mark Lavon Jorgensen, M.S., P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

269867-2401 Issued in UT

Practice address

345 E 9500 S
Paradise, UT 84328-8903

Phone

(435) 764-0710

NPI assigned

Jun 20, 2012

Last updated

May 15, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Aegis Nebraska LLC

  dba Aegis Home Health and Hospice

  • Home Health Agency
  • Omaha, NE
  • NPI 1669213930

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Aegis Nebraska LLC

  dba Aegis Home Health and Hospice

  • Community Based Hospice Care Agency
  • Omaha, NE
  • NPI 1912748286

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Ancora Home Health & Hospice, LLC

  • Community Based Hospice Care Agency
  • Wasilla, AK
  • NPI 1477047579

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Ancora Home Health & Hospice, LLC

  • Home Health Agency
  • Wasilla, AK
  • NPI 1801380043

  5% Or Greater Indirect Ownership Interest

  CMS ownership

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.

• Atlas Medical Alaska LLC

  • Internal Medicine Physician
  • Wasilla, AK
  • NPI 1376213207
  Medicare reassignment
• Ancora Home Health & Hospice, LLC

  • Community Based Hospice Care Agency
  • Wasilla, AK
  • NPI 1477047579
  NPD
• Ancora Home Health & Hospice, LLC

  • Home Health Agency
  • Wasilla, AK
  • NPI 1801380043
  NPD

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1578826947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 E 9500 S",
            "city": "PARADISE",
            "state": "UT",
            "postal_code": "843288903",
            "telephone_number": "435-764-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 E 9500 S",
            "city": "PARADISE",
            "state": "UT",
            "postal_code": "843288903",
            "telephone_number": "435-764-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "MARK",
        "middle_name": "LAVON",
        "credential": "M.S., P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-20",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "269867-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avalon Hills Health Care, Inc
• Rebecka Anderson Bankhead, RD, CD
• Stacie Coombs, LAC
• Leslie Kae Dickey, LPN
• Donald Lee Hebert, MFT
• Mountain Peace Therapy, LLC
• Sensible Nutrition Counseling LLC
• Rebecca Walsman, MSW, LCSW, CCTP
• Nathon D. Wood, PHD,LMFT

• Physical Therapist in Paradise, UT
• Providers in Paradise, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.