Individual provider Active NPI

Erik P Mortensen, NP

  • Adult Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1902055965
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F304475 Issued in NY
Practice address
352 7TH Ave
RM 1205
New York, NY 10001-5411
Phone
(212) 627-7560
Fax
(212) 627-7563
NPI assigned
Sep 15, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F304475 NY Primary

Addresses

Primary practice location

352 7TH Ave
RM 1205
New York, NY 10001-5411

Mailing address

8390 Champions Gate Blvd
Ste 215
Champions Gate, FL 33896-8310
Phone (321) 401-1364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170308000603 NY Practitioner - Nurse Practitioner 1456635655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MVP Medical Practice PCGroup PAC ID 5395970362, 17 clinicians

Practice addresses (Care Compare)

352 7TH Ave
RM 1205
New York, NY 10001-5411
Phone (212) 627-7560

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as group
Quality
81.41
Improvement activities
40
Cost
73.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
304475NYMDOrthopaedic Surgery Physician
F304475NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MVP Medical Practice PC Current Accepting new patients
Ajs Brookyln Medical Practice PC CurrentSince Jan 1, 2017 Accepting new patients
Ajs Brooklyn Medical Practice PC CurrentSince Jan 1, 2017 Accepting new patients

Locations

8390 Champions Gate Blvd
Ste 215
Champions Gate, FL 33896
Phone (407) 479-2013

475 Atlantic Ave
Ste 2
Brooklyn, NY 11217
Phone (718) 369-4850

16121 Jamaica Ave
Fl 7
Jamaica, NY 11432
Phone (718) 896-2500

30 W 60th St
Apt An
New York, NY 10023
Phone (212) 247-6575

365 W 28th St
#A
New York, NY 10001
Phone (212) 284-0060

352 7th Ave
Rm 1205
New York, NY 10001
Phone (212) 627-7560

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: erik.mortensen.1@26356.direct.athenahealth.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1902055965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8390 CHAMPIONS GATE BLVD",
            "address_2": "STE 215",
            "city": "CHAMPIONS GATE",
            "state": "FL",
            "postal_code": "338968310",
            "telephone_number": "321-401-1364",
            "fax_number": "407-390-1765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 7TH AVE",
            "address_2": "RM 1205",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015411",
            "telephone_number": "212-627-7560",
            "fax_number": "212-627-7563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "ERIK",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-15",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F304475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.