Brian E Granvall, PA-C

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

PA-1042 Issued in ID

Practice address

190 E Bannock St
Boise, ID 83712-6241

Phone

(208) 381-2094

Fax

(208) 381-1791

NPI assigned

Feb 13, 2006

Last updated

Jan 31, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brian.granvall@hca6.eclinicaldirectplus.com

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.

• Tellica Imaging, LLC

  • Radiology Clinic/Center
  • Boise, ID
  • NPI 1760197198

  Diagnostic Radiology

  Medicare reassignment NPD
• Cascade Surgical Physician Assistants, PLLC

  • Physician Assistant
  • Vancouver, WA
  • NPI 1811960990
  NPD (past) Authorized official
• Tellica Imaging, LLC

  • Physiological Laboratory
  • Spanish Fork, UT
  • NPI 1518727734
  NPD
• Northwest Emergency Physicians LLC

  dba Nep

  • Emergency Medicine Physician
  • Arlington, WA
  • NPI 1235172370
  NPD (past)

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1205809852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1108",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391108",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2094",
            "fax_number": "208-381-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANVALL",
        "first_name": "BRIAN",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002940",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004399",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA 00846",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C04233",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "PA-1042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "BRIAN.GRANVALL@hca6.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "190 E Bannock St",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837126241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kara Renee Grant, LPC
• Kevin E Grant, M.D.
• Raelynn Fritz Grant, LPC
• Sarina Marie Grant
• Tonia C Grantham, LPN
• David J Grapp, LPC
• Molly Gratton, LSCSW
• Valeri Grave, PAC
• Brendon Bogedahl Graves
• Naila Kajdic Graves

• Diagnostic Radiology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Diagnostic Radiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.

Verify at the official NPI Registry.