Active NPI
Samuel Paul Grantham, DNP
- Family Nurse Practitioner
- Bremerton, WA
National Provider Identifier
1144965187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 325562
- Practice address
- 1 Boone Rd
Bremerton, WA 98312-1898 - Phone
- (360) 475-4000
- NPI assigned
- May 4, 2022
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 325562 | AZ | Primary |
Addresses
Primary practice location
1 Boone Rd
Bremerton, WA 98312-1898
Mailing address
4301 Jones Bridge Rd
Bethesda, MD 20814-4799
Phone (301) 295-9004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260120001294 | AZ | Order and Referring Only - Nurse Practitioner | 3375020597 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 325562 | AZ | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751414400000",
"number": "1144965187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 JONES BRIDGE RD",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208144799",
"telephone_number": "301-295-9004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOONE RD",
"city": "BREMERTON",
"state": "WA",
"postal_code": "983121898",
"telephone_number": "360-475-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANTHAM",
"first_name": "SAMUEL",
"middle_name": "PAUL",
"credential": "DNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-04",
"last_updated": "2025-07-02",
"certification_date": "2025-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "325562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bremerton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.