DR. SAMUEL A MORTENSEN D.M.D
NPI 1427240282
Dentist - General Practice in Phoenix, AZ

Q: What is Samuel Mortensen's NPI number?

The NPI number for Samuel Mortensen is 1427240282. It was assigned to this individual provider in the NPPES registry on August 15, 2007.

Q: What is Samuel Mortensen's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Mortensen was last updated on July 29, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.

Active since August 15, 2007PECOS Enrolled

4212 N 16TH ST, PHOENIX, AZ 85016(602) 263-1200(602) 200-5383 Get Directions Write a Review

NPPES record last updated: July 29, 2015. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Dr. Samuel A Mortensen D.m.d NPPES

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

DR. SAMUEL A MORTENSEN D.M.D (NPI 1427240282) is an individual general practice provider in Phoenix, Arizona, licensed in Arizona (7351) and active in the NPI registry since August 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1427240282

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. SAMUEL A MORTENSENCredential: D.M.D

Location Address4212 N 16TH STPhoenix, AZ 85016-5319

Mailing Address4212 N 16th StPhoenix, AZ 85016-5319 · (602) 263-1200 · Fax (602) 200-5383

Phone(602) 263-1200

Fax(602) 200-5383

Sole ProprietorNo

Enumeration DateAugust 15, 2007

Last NPPES UpdateJuly 29, 2015

✔ NPI 1427240282 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Licenses✔ Licensed in AZ · 7351✔ Licensed in CO · DEN.00201822

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

4212 N 16TH ST, Phoenix, AZ 85016

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Samuel A Mortensen D.m.d is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Medicare Billing Reassignment

Medicare enrollment records show Samuel Mortensen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dhew Ind Hlth Sv Hlth Svs & Mntl Hlth Adm

Same address

Public Health or Welfare

4212 N 16TH ST
Phoenix, AZ 85016

Reassigned Medicare billing, Texas enrollment
599 clinicians in this Medicare group

NPI 1083643738 (602) 263-1200

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85016 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$69.24 typical visit price

range $17.72 – $137.41

Typical copayment $17.31 (range $4.43 – $34.35)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WENDY RAZO

Registered Nurse (Obstetric, High-Risk)