Mark Jason Granada, AGNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

95024681 Issued in CA

Practice address

857 W Childs Ave
Merced, CA 95341-6862

Phone

(209) 722-4842

NPI assigned

Nov 15, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regents of the University of CaliforniaGroup PAC ID 8022922475, 562 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Regents of the University of California

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1952998973
  Medicare reassignment Care Compare group NPD
• Golden Valley Health Centers

  • Federally Qualified Health Center (FQHC)
  • Turlock, CA
  • NPI 1356445753
  Medicare reassignment NPD
• Paltm, Medical Corporation

  • Adult Medicine Physician
  • Sacramento, CA
  • NPI 1194455402
  Medicare reassignment NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Planada, CA
  • NPI 1235114745
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1346224417
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Le Grand, CA
  • NPI 1356325310
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Merced, CA
  • NPI 1508333253
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Modesto, CA
  • NPI 1518298306
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Merced, CA
  • NPI 1528042512
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Newman, CA
  • NPI 1689658668
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Banos, CA
  • NPI 1730163734
  NPD
• Golden Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Dos Palos, CA
  • NPI 1770567778
  NPD

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1386353761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 CUSTOMER CARE WAY",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953015167",
            "telephone_number": "209-722-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "857 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416862",
            "telephone_number": "209-722-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANADA",
        "first_name": "MARK JASON",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-15",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95024681",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95024681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Goodwyn, LVN
• Timothy Goosby, CRNA
• Jon Pratt Gossett
• Ebony A Goytia Hermosillo
• Gary C Graham, M.D.
• David Granados Lua
• Gorge Carlo Vizcarra Granados
• Vanessa Katrina Granados I
• Kennisha Michelle Grant
• Ayanna Gray-Presley

• Gerontology Nurse Practitioner in Merced, CA
• Providers in Merced, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.