JON DERIK MORTENSEN (PAC) – Medical Physician Assistant, NPI 1407930456
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,282 PHYSICIAN ASSISTANT in WA
Loading map...
Provider Addresses for JON DERIK MORTENSEN (PAC)
Pacific Avenue, Tacoma, Pierce County, Washington, 98418-7826, United States
ATTN HR
TACOMA, WA 984024488
Phone: (253) 722-1540
Type: Mailing
Gravelly Lake Drive & Steilacoom Boulevard, Gravelly Lake Drive Southwest, Lakewood Plaza Apartments, Lakewood, Pierce County, Washington, 98499, United States
COMMUNITY HEALTH CARE - LAKEWOOD CLINIC
LAKEWOOD, WA 98499
Phone: (253) 589-7030
Fax: (253) 589-7033
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $70.
Total Amount is formed as General ($70) + Research ($0) + Ownership ($0) = $70.
Last reported payment date: 2024-10-11 • Largest payer in this snapshot: Genentech USA, Inc. ($70).
Total Amount
$70
General + Research + Ownership
Payments
1
Total payment records
General Amount
$70
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Genentech USA, Inc. | $70 |
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: 2007-01-15
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 |
|---|---|---|---|---|
| I20070115000277 | I | Physician Assistant | WA | 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 |
|---|---|---|---|---|
| 83036 | Hemoglobin a1c level | 26 | 16 | $0 |
Insurance plans in this area (ZIP 98402)
Loading plans...
Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | WA | 83036 | Hemoglobin A1C level | 28 | 21 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WA | |
| Physician Assistant | WA | |
| Family Practice | WA | |
| Family Practice | OR | |
| Osteopathic Manipulative Medicine | WA | |
| Nurse Practitioner | CT | |
| Family Practice | WA | |
| Family Practice | WA | |
| - | WA | |
| Nurse Practitioner | WA |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.