MARTY JAY MORTIMER (NPI# 1689732810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689732810 |
| Entity Type | Individual |
| Full Name | MARTY JAY MORTIMER |
| Credential | PA-C |
| Practice Address |
8501 Meadow Crk Rockford MI 49341-7524 |
| Mailing Address |
100 Michigan St Ne # Mc845 Grand Rapids MI 49503-2560 |
| Practice Telephone | 6162677884 |
| Mailing Telephone | (616) 486-6790 |
| Mailing Fax Number | 6164866702 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2017-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5601006939 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
8501 MEADOW CRK |
| City | ROCKFORD |
| State | MI |
| Zip Code | 49341-7524 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225032709 | Philip E Henderson | Internal Medicine | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2005-06-13 |
| 1740849611 | Diane Marie Vancamp | Pharmacist | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2019-06-13 |
| 1790299253 | Stephanie Anne Vander Velde | Physician Assistant | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2017-11-20 |
| 1477072700 | Dulcie Yancharas | Social Worker | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2017-09-19 |
| 1437692415 | Deborah St Pierre | Nurse Practitioner | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2016-11-23 |
| 1033569587 | Amber Gall | Nurse Practitioner | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2016-06-15 |
| 1528444833 | Travis Ryan Guest | Physician Assistant | 8501 Meadow Crk, Rockford, MI 49341 | 2015-08-10 |
| 1235511668 | Caesy Lewis Yarling | Neuromusculoskeletal Medicine & OMM | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2015-06-22 |
| 1982086302 | Matthew Bottke | Family Medicine | 8501 Meadow Crk, Rockford, MI 49341 | 2015-06-22 |
| 1346621356 | Tristale Williams | Social Worker | 8501 Meadow Crk, Rockford, MI 49341-7524 | 2015-06-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801451836 | Heather Nash | Social Worker | 65 S. Main Street, Lower Level, Rockford, MI 49341 | 2019-05-06 |
| 1366967069 | Caitlin Lebron | Case Manager/Care Coordinator | 8625 Wildcat Run Dr Ne, Rockford, MI 49341 | 2017-08-03 |
| 1366967077 | Elite Nurse Staffing, LLC | Nursing Care | 3836 Windwood Drive, Ne, Rockford, MI 49341 | 2017-08-03 |
| 1336678747 | Melissa Diane Maynard | Behavior Technician | 3361 36th St., Grand Rapids, MI 49341 | 2017-06-08 |
| 1376077453 | Spectrum Health Primary Care Partners | Internal Medicine | 8501 Meadowcreek Dr, Rockford, MI 49341 | 2017-04-17 |
| 1871025254 | Robin D Dine | Behavior Technician | 8636 Shaner Ave, Rockford, MI 49341 | 2017-04-03 |
| 1528503216 | Miles Skalnek | Pharmacist | 511 10 Mile Road, Rockford, MI 49341 | 2017-01-04 |
| 1366801664 | Lorri Ann Kelbel | Massage Therapist | 11591 Northland Drive Ne, Rockford, MI 49341 | 2016-02-15 |
| 1275872046 | Eugene Louis Bonofiglo | Dentist | 4655- 14 Mile Rd Ne, Rockford, MI 49341 | 2013-02-13 |
| 1740539246 | Erica Joyce Nichols | Chiropractor | 6769 Courtland Dr, Suite 100, Rockford, MI 49341 | 2012-08-30 |
| Find all providers in zip 49341 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871063776 | Amira Al-basha | Physician Assistant | 1639 N Alpine Rd Ste 380, Rockford, IL 61107-1440 | 2018-12-04 |
| 1578042982 | Alyssa Margaret Vasylyuk | Physician Assistant | 2350 N Rockton Ave Fl 4, Rockford, IL 61103-3600 | 2018-08-08 |
| 1053778456 | Jamie Anticevich | Physician Assistant | 6595 East State Street, Rockford, IL 61108-2542 | 2016-01-15 |
| 1437534666 | Irene Dyer | Physician Assistant | 1560 Red Oak Ln, Rockford, IL 61107-2767 | 2015-07-29 |
| 1215250675 | Krista R Mohamed | Physician Assistant | 1401 E. State St., Swedish American Hospital, Rockford, IL 61104-2315 | 2010-03-12 |
| 1629121009 | Jason A. Kadar | Physician Assistant | 2902 Mcfarland Rd Ste 300, Rockford, IL 61107-6801 | 2007-01-19 |
| 1295805851 | Kristin Lynn King-shank | Physician Assistant | 171 Dogwood Dr Ne, Rockford, MI 49341-7361 | 2006-11-09 |
| 1245263268 | William John Stout | Physician Assistant | 1401 E State Street, Rockford, IL 61104 | 2006-07-10 |
| 1952356040 | Saint Anthony Medical Center | Physician Assistant | 6830 Villagreen Vw, Rockford, IL 61107-5639 | 2006-05-24 |
| 1972552131 | Andrea B Fulcomer | Physician Assistant | 2404 Charles St, Rockford, IL 61108-1602 | 2006-05-08 |
| Find all providers in ROCKFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.