Jerry H Grant, M.D., P.a. – Clinic/Center

Key facts

NPI: 1366745705
Entity type: Organization (NPI type 2)
Primary specialty: Clinic/Center 261Q00000X
License: E-0952 (AR)
Legal business name: JERRY H GRANT, M.D., P.A.
Practice address: 104 E Grove St
El Dorado, AR 71730
Phone: (870) 862-2285
Fax: (870) 862-2289
NPI assigned: Dec 7, 2010
Organization subpart: No

Authorized official

Name: Dr. Jerry Henry Grant, M.D. NPI 1396714424
Title: Owner/Physician
Phone: (870) 862-2285

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Jerry H Grant, MD Family Medicine Physician · El Dorado, AR · NPI 1396714424

Medicare reassignment NPD Authorized official AR
Gianna M Grant, APN Family Nurse Practitioner · El Dorado, AR · NPI 1427026939

Medicare reassignment NPD AR

Medicare participation

Medicare fee-for-service enrollment: Enrolled in AR

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20110113000564	AR	Part B Supplier - Clinic/Group Practice	2769671387	Receives reassigned benefits from 2 practitioners Practice locations: El Dorado, AR

National Provider Directory

Locations

104 E Grove St
El Dorado, AR 71730
Phone (870) 862-2285

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinic/Center	261Q00000X	E-0952	AR	Yes

Addresses

Primary practice location

104 E Grove St
El Dorado, AR 71730

Mailing address

104 E Grove St
El Dorado, AR 71730-4607
Phone (870) 862-2285

Other practice location 1

104 E Grove St
El Dorado, AR 71730
Phone (870) 862-2285

Other identifiers

Identifier	Type	State	Issuer
130237001	Medicaid	AR
080128979	Other	AR	RAILROAD MEDICARE

Other names

GrantMED Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 7, 2019.

{
    "created_epoch": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1366745705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E GROVE ST",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304607",
            "telephone_number": "870-862-2285",
            "fax_number": "870-862-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E GROVE ST",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "71730",
            "telephone_number": "870-862-2285",
            "fax_number": "870-862-2289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 E Grove St",
            "address_purpose": "LOCATION",
            "city": "El Dorado",
            "state": "AR",
            "postal_code": "71730",
            "country_code": "US",
            "telephone_number": "870-862-2285",
            "fax_number": "870-862-2289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JERRY H GRANT, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-07",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "870-862-2285",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": "E-0952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130237001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080128979",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GrantMED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado, AR

All providers in El Dorado, AR · Clinic/Center in Arkansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.