NPIMap

Organization Active NPI

Granger Medical Specialists LLC

  • Clinic/Center
  • West Valley City, UT
National Provider Identifier
1376159368
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GRANGER MEDICAL SPECIALISTS LLC
Practice address
2965 W 3500 S
West Valley City, UT 84119-3602
Phone
(801) 965-3600
NPI assigned
Sep 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Mary Jane Pennington, MDNPI 1205868452
Title
President/Ceo
Phone
(801) 965-3600

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 Primary

Addresses

Primary practice location

2965 W 3500 S
West Valley City, UT 84119-3602

Mailing address

7181 S Campus View Dr Ste 200
West Jordan, UT 84084-4312
Phone (801) 965-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201105002207 UT Part B Supplier - Clinic/Group Practice 4587074356 Receives reassigned benefits from 242 practitioners
Practice locations: Taylorsville, UT
O20220221000924 UT DME Supplier - Multi-Specialty - Physician 4587074356 Practice locations: West Valley City, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 364

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

View all 364

NPI Registry JSON

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1376159368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7181 S CAMPUS VIEW DR STE 200",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840844312",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER MEDICAL SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "MARY JANE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "801-965-3600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.