MARTY JAY MORTIMER (PA-C) – Physician Assistant, NPI 1689732810
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
6,066 PHYSICIAN ASSISTANT in MI
Provider Addresses for MARTY JAY MORTIMER (PA-C)
100 MICHIGAN ST NE # MC845
GRAND RAPIDS, MI 495032560
Phone: (616) 486-6790
Fax: (616) 486-6702
Type: Mailing
8501 MEADOW CRK
ROCKFORD, MI 493417524
Phone: (616) 267-7884
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-07-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140707000230 | I | Physician Assistant | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 84 | 65 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 63 | 58 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 15 | 15 | $0 |
| 93005 | Routine electrocardiogram (ecg) using at least 12 leads with tracing | 13 | 13 | $0 |
Insurance plans in this area (ZIP 49503)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Critical Care (Intensivists) | IL | |
| Physician Assistant | MI | |
| Physician Assistant | MI | |
| Physician Assistant | MI | |
| - | MI | |
| Vascular Surgery | IL | |
| - | MI | |
| - | MI | |
| A N E S T H E S I O L O G Y | TX | |
| Clinical Social Worker | MI |
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