Individual provider Active NPI

Jeremy Grigg

  • Physician Assistant
  • Little Rock, AR
National Provider Identifier
1336820679
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4301 W Markham St
Little Rock, AR 72205-7101
Phone
(501) 686-7211
NPI assigned
Jul 28, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

4301 W Markham St
Little Rock, AR 72205-7101

Mailing address

248 N Tanzanite TRL Apt 8
Fayetteville, AR 72701-7687
Phone (870) 715-7471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20241112000174 AR Practitioner - Physician Assistant 8022542257 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

2710 S Rife Medical LN
Mercy Rogers Hospital
Rogers, AR 72758-1452
Phone (479) 338-8000

Hospital & facility affiliations

  • Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
  • Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Physician Assistant CurrentSince Mar 1, 2026 Accepting new patients

Locations

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

2710 S Rife Medical Ln
Rogers, AR 72758
Phone (479) 338-8000

Organizations & group practices 2

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.

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": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1336820679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 N TANZANITE TRL APT 8",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727017687",
            "telephone_number": "870-715-7471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-686-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIGG",
        "first_name": "JEREMY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-28",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.