NPIMap

Organization Active NPI

Jerry H Grant, M.D., P.a.

Doing business as GrantMED

  • Clinic/Center
  • El Dorado, AR
National Provider Identifier
1366745705
Registry record updated Aug 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
E-0952 Issued in AR
Legal business name
JERRY H GRANT, M.D., P.A.
Doing business as
GrantMED
Practice address
104 E Grove St
El Dorado, AR 71730
Phone
(870) 862-2285
Fax
(870) 862-2289
NPI assigned
Dec 7, 2010
Last updated
Aug 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2019

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

Authorized official

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

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X E-0952 AR Primary

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 names 1

  • GrantMED Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110113000564 AR Part B Supplier - Clinic/Group Practice 2769671387 Receives reassigned benefits from 2 practitioners
Practice locations: El Dorado, AR

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GrantMED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare 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.