Theresa Louise Mortensen, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

402482 Issued in CA

Practice address

3555 Round Barn Cir
Santa Rosa, CA 95403-1757

Phone

(707) 528-1050

Fax

(707) 525-3874

NPI assigned

Oct 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
• Sonoma Valley Hospital Hospital, Sonoma, CA, CCN 050090
• Petaluma Valley Hospital Hospital, Petaluma, CA, CCN 050136
• Healdsburg Hospital Hospital, Healdsburg, CA, CCN 051321

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theresa.mortensen@stjoe.direct.varian.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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD (past)
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Redwood Regional Medical Group Inc

  • Hematology & Oncology Physician
  • Santa Rosa, CA
  • NPI 1275556607

  Nurse Practitioner

  NPD (past)

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

• Norcal Healthconnect LLC

  • General Acute Care Hospital
  • Petaluma, CA
  • NPI 1235162645
  Care Compare affiliation
• Norcal Healthconnect LLC

  • Multi-Specialty Clinic/Center
  • Healdsburg, CA
  • NPI 1720695547

  Hospital

  Care Compare affiliation
• Norcal Healthconnect LLC

  • Critical Access Hospital
  • Healdsburg, CA
  • NPI 1861009672
  Care Compare affiliation
• Sonoma Valley Health Care District

  • General Acute Care Hospital
  • Sonoma, CA
  • NPI 1710063870
  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  Care Compare affiliation

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1972683753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 ROUND BARN CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031757",
            "telephone_number": "707-528-1050",
            "fax_number": "707-525-3874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 ROUND BARN CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031757",
            "telephone_number": "707-528-1050",
            "fax_number": "707-525-3874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "THERESA",
        "middle_name": "LOUISE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "402482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN402482",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmortensen1647966@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "3555 Round Barn Cir",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954031757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmortensen1647966@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "110 Lynch Creek Way Ste A",
            "city": "Petaluma",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949542337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jonathan Morse, M.D.
• Thomas Friedrich Morse
• Afrooz Mortazavi
• Rene L Morten
• Lynn Mortensen, MD
• Yogita Mosalpuria, MD
• Robert Davis Mosby, PH.D
• Sarah Rose Moschiano
• Kathleen I Moser
• Harvey Moskovitz, MD

• Nurse Practitioner in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.