Active NPI
Jed D. Grant, PA-C
- Physician Assistant
- Tulare, CA
National Provider Identifier
1124064548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA15317
- Practice address
- 869 North Cherry Street
Tulare, CA 93274-2287 - Phone
- (559) 695-3450
- Fax
- (559) 685-3869
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA15317 | CA | Primary |
Addresses
Primary practice location
869 North Cherry Street
Tulare, CA 93274-2287
Mailing address
2550 North Hollywood Way
Suite 209
Burbank, CA 91505-5019
Phone (818) 557-0135
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA15312 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110118000810 | CA | Practitioner - Physician Assistant | 9830104280 | Reassigns benefits to 3 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15312 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America- California | Current | Accepting new patients | |
| Sutter Valley Medical Foundation | Physician Assistant | Current | Accepting new patients |
| Sutter Valley Medical Foundation | Current | Accepting new patients | |
| Prairie Schooner Emergency Physicians, a Medical Corporation | Physician Assistant | Past | Accepting new patients |
| Emergency Department Physicians Medical Group, Inc. | Past | Accepting new patients |
Locations
2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000
2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731
115 Mall Dr
Hanford, CA 93230
Phone (559) 537-0550
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000
2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850
869 N Cherry St
Tulare, CA 93274
Phone (559) 326-2800
Interoperability endpoints
- jgrant352790@hisp.ehr.sutterhealth.org
Organizations & group practices 8
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.
-
- Emergency Medicine Physician
- Woodland, CA
- NPI 1881868164
CA
-
- Emergency Medicine Physician
- Tehachapi, CA
- NPI 1912776329
-
- Multi-Specialty Clinic/Center
- Fairfield, CA
- NPI 1184859894
Physician Assistant
-
- Durable Medical Equipment & Medical Supplies
- Tracy, CA
- NPI 1720930712
-
- Emergency Medicine Physician
- Los Angeles, CA
- NPI 1730104498
-
- Emergency Medicine Physician
- Porterville, CA
- NPI 1205035581
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297641600000",
"number": "1124064548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 NORTH HOLLYWOOD WAY",
"address_2": "SUITE 209",
"city": "BURBANK",
"state": "CA",
"postal_code": "915055019",
"telephone_number": "818-557-0135",
"fax_number": "818-557-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "869 NORTH CHERRY STREET",
"city": "TULARE",
"state": "CA",
"postal_code": "932742287",
"telephone_number": "559-695-3450",
"fax_number": "559-685-3869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "JED",
"middle_name": "D.",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2011-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA15317",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PA15312",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulare, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.