NPIMap

Individual provider Active NPI

Wayne Marcus Mortensen, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
National Provider Identifier
1780878314
Registry record updated Jan 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M12065 Issued in ID
Practice address
190 E Bannock St
Boise, ID 83712-6241
Phone
(208) 381-2094
Fax
(208) 381-1791
NPI assigned
Aug 27, 2007
Last updated
Jan 10, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 0116019824 VA
Student in an Organized Health Care Education/Training Program 390200000X 7152301-1205 UT
Student in an Organized Health Care Education/Training Program 390200000X 7152301-8905 UT
Diagnostic Radiology Physician 2085R0202X M12065 ID Primary

Addresses

Primary practice location

190 E Bannock St
Boise, ID 83712-6241

Mailing address

PO Box 1108
Corvallis, OR 97339-1108
Phone (208) 381-2094

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130821000516 ID Practitioner - Diagnostic Radiology 6305094616 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
George Washington University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Weiser Valley Hospital DistrictGroup PAC ID 5294704276, 60 clinicians
Boise Radiology Group PLLCGroup PAC ID 9638153257, 64 clinicians
North Canyon Medical Center IncGroup PAC ID 0941371439, 73 clinicians

Practice addresses (Care Compare)

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 549-0370

267 N Canyon Dr
Gooding, ID 83330-5500
Phone (208) 934-4433

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.94 of 100Reported as group
Quality
92.87
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
7152301-1205UTMDStudent in an Organized Health Care Education/Training Program
7152301-8905UTMDStudent in an Organized Health Care Education/Training Program
0116019824VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Weiser Valley Hospital District CurrentSince Aug 5, 2013 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Oct 1, 2019 Accepting new patients
North Canyon Medical Center Inc. Current Accepting new patients
Weiser Valley Hospital District Diagnostic Radiology CurrentSince Aug 5, 2013 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Oct 1, 2019 Accepting new patients
Boise Radiology Group PLLC Diagnostic Radiology CurrentSince Aug 1, 2013 Accepting new patients
University Radiology Associates Diagnostic Radiology PastSince Feb 1, 1997 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

100 E Idaho St
Boise, ID 83712
Phone (208) 343-3223

1000 E Park Blvd
Boise, ID 83712
Phone (208) 381-4100

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2235

600 N Robbins Rd
Boise, ID 83702
Phone (208) 489-4444

701 E Parkcenter Blvd
Boise, ID 83706
Phone (208) 381-6400

703 S Americana Blvd
Boise, ID 83702
Phone (208) 706-6375

3101 E State St
Eagle, ID 83616
Phone (208) 473-3100

1210 NW 16th St
Fruitland, ID 83619
Phone (208) 452-8600

267 N Canyon Dr
Gooding, ID 83330
Phone (208) 934-4433

3140 W Milano Dr
Ste 150
Meridian, ID 83646
Phone (208) 887-4775

3277 E Louise Dr
Ste 100
Meridian, ID 83642
Phone (208) 706-5217

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

895 N 6th E
Mtn Home, ID 83647
Phone (208) 580-2661

9850 W St Lukes Dr
Nampa, ID 83687
Phone (208) 205-7282

645 E 5th St
Weiser, ID 83672
Phone (208) 549-0370

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1780878314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1108",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391108",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "WAYNE",
        "middle_name": "MARCUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-27",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116019824",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "UT",
            "license": "7152301-1205",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "UT",
            "license": "7152301-8905",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M12065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.