Wayne A Mortensen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-4220 Issued in ID

Practice address

9213 W State St
Boise, ID 83714-1737

Phone

(208) 853-3300

NPI assigned

Jun 22, 2009

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

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wayne Mortensen DMD PC

  • Dental Clinic/Center
  • Boise, ID
  • NPI 1134885684
  NPD Authorized official

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544400000000",
    "number": "1801023478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9213 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837141737",
            "telephone_number": "208-853-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9213 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837141737",
            "telephone_number": "208-853-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "317 W Cherry Ln",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836421608",
            "country_code": "US",
            "telephone_number": "208-395-1000",
            "fax_number": "208-895-0583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "WAYNE",
        "middle_name": "A",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-22",
        "last_updated": "2018-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4220",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lenore Filler Morrissey, MPT, DPT, OCS, CFC
• Elise Morrow
• Tesa Suzanne Morrow, LPN
• Matthew Mors, D.O.
• Jeremy Mortensen, CRNA
• Wayne Marcus Mortensen, M.D.
• Margaret K Mortimer, NP
• Douglas Eugene Morton, PT
• Laura Morton, NP
• Ryan Alan Morton, MD

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; 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.