Garrett Kordsiemon, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9374356-1206 Issued in UT

Practice address

12391 S 4000 W
Riverton, UT 84096-7012

Phone

(801) 965-3600

NPI assigned

Aug 2, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians

Interventional Spine and Pain ManagementGroup PAC ID 6204065162, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Granger Medical Clinic PC

  • Multi-Specialty Clinic/Center
  • West Valley City, UT
  • NPI 1184657041

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Interventional Spine & Pain Management

  • Pain Medicine (Anesthesiology) Physician
  • Murray, UT
  • NPI 1609204338
  Medicare reassignment Care Compare group
• Granger Medical Specialists LLC

  • Clinic/Center
  • West Valley City, UT
  • NPI 1376159368
  Medicare reassignment NPD
• Granger Medical Clinic PC

  • Specialist
  • Salt Lake City, UT
  • NPI 1356425672
  NPD
• Granger Medical Clinic PC

  • Medical Specialty Clinic/Center
  • Sandy, UT
  • NPI 1871320028
  NPD
• Granger Medical Specialists, LLC

  • Multi-Specialty Clinic/Center
  • Salt Lake City, UT
  • NPI 1497441539
  NPD
• Interventional Spine & Pain Management

  • Pain Medicine Physician
  • Ogden, UT
  • NPI 1992342414
  NPD
• Granger Medical Clinic PC

  • Multi-Specialty Clinic/Center
  • West Jordan, UT
  • NPI 1104857549
  NPD (past)

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1114654027",
    "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": "12391 S 4000 W",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840967012",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 N Renaissance Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871077002",
            "country_code": "US",
            "telephone_number": "505-266-5565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORDSIEMON",
        "first_name": "GARRETT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-02",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "9374356-1206",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Malechek Klimes, MD
• McKenzi Lynn Knell
• Shaeleigh Jade Knell
• Evangeline Kobayashi, MD
• Joyce Elizabeth Koplin
• Trevor Nichols Labrum, D.D.S.
• Jeanne Lajom, P.T.
• Bethany Christine Lambson, CNM
• Peter Demarcus Lambson, AMFT
• Andrea Lanao Roth-Roffy, DO

• Medical Physician Assistant in Riverton, UT
• Providers in Riverton, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.