BLAKE C. MORTENSON (M.D.) – Diagnostic Radiology Physician, NPI 1427056860
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
345 DIAGNOSTIC RADIOLOGY in UT
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Provider Addresses for BLAKE C. MORTENSON (M.D.)
PO BOX 1108
BOUNTIFUL, UT 840111108
Phone: (801) 296-2113
Fax: (801) 296-1715
Type: Mailing
1400, North 500 East, Logan, Cache County, Utah, 84341, United States
LOGAN, UT 843412455
Phone: (435) 716-1000
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: 2010-11-05
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20031120000932 | I | Diagnostic Radiology | ID | TBD |
| I20101105000721 | I | Diagnostic Radiology | UT | 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 |
|---|---|---|---|---|
| 77067 | Screening mammography | 212 | 212 | $0 |
| 77063 | Screening 3d breast mammography | 212 | 212 | $0 |
| 71045 | X-ray of chest, 1 view | 182 | 166 | $0 |
| 71046 | X-ray of chest, 2 views | 133 | 131 | $0 |
| 74177 | Ct scan of abdomen and pelvis with contrast | 110 | 103 | $0 |
Insurance plans in this area (ZIP 84011)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | UT | 71250 | CT scan chest | 22 | 22 |
| DIAGNOSTIC RADIOLOGY | UT | 73562 | X-ray of knee, 3 views | 37 | 31 |
| DIAGNOSTIC RADIOLOGY | UT | 73630 | X-ray of foot, minimum of 3 views | 22 | 21 |
| DIAGNOSTIC RADIOLOGY | UT | 74177 | CT scan of abdomen and pelvis with contrast | 83 | 77 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| Diagnostic Radiology | UT | |
| Family Practice | UT | |
| H O S P I T A L I S T | UT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | UT | |
| - | UT | |
| - | UT | |
| - | UT | |
| Family Practice | UT | |
| - | UT |
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