NPIMap

Organization Active NPI

Granger Medical Clinic PC

  • Multi-Specialty Clinic/Center
  • West Jordan, UT
National Provider Identifier
1104857549
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GRANGER MEDICAL CLINIC PC
Practice address
3181 W 9000 So
West Jordan, UT 84088
Phone
(801) 352-5900
Fax
(801) 352-5914
NPI assigned
Jul 5, 2006
Organization subpart
Yes
Parent organization
GRANGER MEDICAL CLINIC PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Jane Pennington, MD
Title
President
Phone
(801) 965-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3181 W 9000 So
West Jordan, UT 84088

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3600

Other names 1

  • Granger Medical West Jordan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031105000159 UT Part B Supplier - Clinic/Group Practice 3476465691 Receives reassigned benefits from 239 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT; Sandy, UT; Tooele, UT; West Jordan, UT; West Valley City, UT; Draper, UT; American Fork, UT; Bountiful, UT…
O20100930071545 UT DME Supplier - Physician - General Practice 3476465691 Practice locations: West Jordan, UT

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D0669065Granger Medical West Jordan Clinic3181 W 9000 S, West Jordan, UT 84088Provider-performed microscopyMar 20, 2028

National Provider Directory

National Provider Directory
Part of
David W McCray M D

Locations

1551 Renaissance Towne Dr
#330
Bountiful, UT 84010

11724 S State St
Draper, UT 84020
Phone (801) 576-2000

150 N Main St
Ste 205
Heber City, UT 84032
Phone (435) 565-1286

1776 N Highway 40
Heber City, UT 84032
Phone (801) 812-4624

181 E 5600 S
Ste 130
Murray, UT 84107
Phone (801) 266-8664

8178 Gorgoza Pines Rd
Unit 8H
Park City, UT 84098
Phone (801) 747-7244

8178 Gorgoza Pines Rd
Ste 8H
Park City, UT 84098

348 E 4500 S
Salt Lake City, UT 84107
Phone (801) 839-5481

1880 S 1045 W
Salt Lake City, UT 84104
Phone (801) 658-4651

1121 E 3900 S
Ste 130
Salt Lake City, UT 84124

6322 S 3000 E
Salt Lake City, UT 84121

5323 S Woodrow St
Ste 201
Salt Lake City, UT 84107
Phone (801) 261-4711

8706 S 700 E
Sandy, UT 84070

9600 S 1300 E
Ste 220
Sandy, UT 84094
Phone (801) 571-0009

9600 S 1300 E
Ste 240
Sandy, UT 84094
Phone (801) 571-5121

9660 S 1300 E
Ste 60
Sandy, UT 84094

9600 S 1300 E
Ste 20
Sandy, UT 84094

1160 E 3900 S
Ste 1000
Slc, UT 84124
Phone (801) 262-1771

995 W Levoy Dr
Taylorsville, UT 84123

2326 N 400 E
Ste 203
Tooele, UT 84074
Phone (435) 830-6110

71 E 1280 N
Tooele, UT 84074
Phone (801) 260-5864

9001 S 3200 W
Ste 3
West Jordan, UT 84088

9001 S 3200 W
West Jordan, UT 84088
Phone (801) 569-5520

9001 S 3200 W
Ste 2
West Jordan, UT 84088

Practitioners & affiliated clinicians

Practitioners 176

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 176

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1104857549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 W 9000 SO",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "84088",
            "telephone_number": "801-352-5900",
            "fax_number": "801-352-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER MEDICAL CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANGER MEDICAL CLINIC PC",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-09-02",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "MARY JANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-965-3600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granger Medical West Jordan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.