Individual provider Active NPI

Jennifer Marie Grant, PA

  • Physician Assistant
  • Oregon City, OR
National Provider Identifier
1144497736
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA212952 Issued in OR
Practice address
1420 John Adams St
Oregon City, OR 97045-1609
Phone
(503) 656-1484
Fax
(503) 650-1976
NPI assigned
May 13, 2008
Last updated
Aug 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005270 GA
Physician Assistant 363A00000X PA212952 OR Primary

Addresses

Primary practice location

1420 John Adams St
Oregon City, OR 97045-1609

Mailing address

PO Box 1517
Pendleton, OR 97801-0410
Phone (877) 708-1119

Other practice location 1

140 N Crest Blvd
Macon, GA 31210-1845
Phone (478) 757-8335

Other names 1

  • Mrs. Jennifer Marie Mullis Grant Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20230313000626 OR Practitioner - Physician Assistant 4981883618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

1420 John Adams St
Oregon City, OR 97045-1609
Phone (503) 656-1484

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
005270GAMDPhysician Assistant
PA212952ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Jul 1, 2025 Accepting new patients
Praxis Health, PC CurrentSince Jul 1, 2025 Accepting new patients
Collier B. Gladin, Jr., M.D., LLC PastSince Jul 26, 2022 Accepting new patients

Locations

4510 SW Hall Blvd
Beaverton, OR 97005
Phone (503) 644-1171

1420 John Adams St
Oregon City, OR 97045
Phone (503) 655-7235

Interoperability endpoints

  • Direct secure messaging: jgrant2620308@oc.providencedirect.org

Organizations & group practices 3

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1144497736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "877-708-1119",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 JOHN ADAMS ST",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970451609",
            "telephone_number": "503-656-1484",
            "fax_number": "503-650-1976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 N Crest Blvd",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312101845",
            "country_code": "US",
            "telephone_number": "478-757-8335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRANT",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-13",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005270",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA212952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MULLIS GRANT",
            "middle_name": "MARIE",
            "prefix": "MRS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oregon City, OR

Sources for this page

Verify at the official NPI Registry.