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JON DERIK MORTENSEN PAC
NPI 1407930456
Physician Assistant - Medical in Lakewood, WA

Active since October 25, 2006PECOS EnrolledAccepts Medicare Assignment
10510 GRAVELLY LAKE DR., COMMUNITY HEALTH CARE - LAKEWOOD CLINIC, LAKEWOOD, WA 98499(253) 589-7030(253) 589-7033 Get Directions Write a Review

NPPES record last updated: June 14, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jon Derik Mortensen Pac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JON DERIK MORTENSEN PAC (NPI 1407930456) is an individual medical provider in Lakewood, Washington, licensed in Washington (PA10005073) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS, is affiliated with St Joseph Medical Center, and is a graduate of Other (2006).

NPPES Registry Identity

NPI1407930456
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameJON DERIK MORTENSENCredential: PAC
Location Address10510 GRAVELLY LAKE DR., COMMUNITY HEALTH CARE - LAKEWOOD CLINICLakewood, WA 98499
Mailing Address1019 Pacific Ave Ste 300, Attn HrTacoma, WA 98402-4488 · (253) 722-1540
Phone(253) 589-7030
Fax(253) 589-7033
Sole ProprietorNo
Medical School CMSOtherGraduated 2006
Enumeration DateOctober 25, 2006
Last NPPES UpdateJune 14, 2012
✔ NPI 1407930456 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in WA · PA10005073
10510 GRAVELLY LAKE DR., Lakewood, WA 98499
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Other Identifiers 2

Medicare PING8876625
Medicaid8469256WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jon Derik Mortensen Pac is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618977703
PECOS Enrollment IDI20070115000277
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Joseph Medical Center

Acute Care Hospitals · Tacoma, WA
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number500108
Location1717 South J StreetTacoma, WA 98405 · Pierce County
Emergency services Birthing friendly

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
7 suppliers23 claims44 services$3.69 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jon Mortensen's NPI number?

The NPI number for Jon Mortensen is 1407930456. It was assigned to this individual provider in the NPPES registry on October 25, 2006.

Where is Jon Mortensen located?

Jon Mortensen practices at 10510 Gravelly Lake Dr. Community Health Care - Lakewood Clinic, Lakewood, WA 98499. The listed phone number is (253) 589-7030.

What is Jon Mortensen's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jon Mortensen enrolled in Medicare?

Yes. Jon Mortensen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Jon Mortensen accept?

Health plans from Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Jon Mortensen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Jon Mortensen affiliated with any hospitals?

According to CMS data, Jon Mortensen is affiliated with St Joseph Medical Center.

When was this NPI record last updated?

The NPPES record for Jon Mortensen was last updated on June 14, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.