Duane Bruce Mortenson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA818 Issued in WY

Practice address

555 E Broadway Ave Ste 207
Jackson, WY 83001-8640

Phone

(307) 733-8002

Fax

(307) 733-0032

NPI assigned

Oct 12, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID, WY2 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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Teton County Hospital DistrictGroup PAC ID 4880582295, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Medical Center Hospital, Jackson, WY, CCN 530015

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dmortenson@sjmc.cernerdirect.com

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

• Teton County Hospital District

  • General Practice Physician
  • Jackson, WY
  • NPI 1487818605
  Medicare reassignment Care Compare group NPD
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment NPD
• Brent Blue MD

  • Family Medicine Physician
  • Driggs, ID
  • NPI 1356556518

  WY

  Medicare reassignment
• CC Pocatello LLC

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1538517156
  Medicare reassignment
• Teton Valley Health Care Inc

  • Rural Health Clinic/Center
  • Driggs, ID
  • NPI 1013264183
  Medicare reassignment
• Teton County Hospital District

  • General Practice Physician
  • Jackson, WY
  • NPI 1457665333
  NPD
• Community Care Pocatello PLLC

  • Urgent Care Clinic/Center
  • Pocatello, ID
  • NPI 1265714760
  NPD
• Teton Valley Health Care, Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Driggs, ID
  • NPI 1053669598
  NPD
• Teton Valley Health Care, Inc

  • Rural Health Clinic/Center
  • Victor, ID
  • NPI 1801143029
  NPD
• Grand Teton Medical Clinic

  • Urgent Care Clinic/Center
  • Moran, WY
  • NPI 1891997151
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Teton County Hospital District

  • General Acute Care Hospital
  • Jackson, WY
  • NPI 1801835475
  Care Compare affiliation

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

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1578848487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010428",
            "telephone_number": "307-733-8002",
            "fax_number": "077-330-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE STE 207",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-8002",
            "fax_number": "307-733-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSON",
        "first_name": "DUANE",
        "middle_name": "BRUCE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-12",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "PA818",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137513000",
            "state": "WY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmortenson@sjmc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address for St John's Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "555 E Broadway Ave Ste 207",
            "city": "Jackson",
            "state": "WY",
            "country_code": "US",
            "postal_code": "830018640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Benjamin R Moore, PT
• Ted Olin Morgan Jr., M.D.
• Anahi Morillon-Jimenez, MSW, PCSW
• Deirdre O'Connell Morris
• Eden Elizabeth Morris, MS, RD, LD
• Veldon Ross Moser, DDS
• Mountain Air Medical LLC
• Mountain Physio LLC
• Mountain Therapy PLLC
• Olivia Louise Mountcastle, RDN LDN MS

• Physician Assistant in Jackson, WY
• Providers in Jackson, WY by specialty
• Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.