Garrett Ryan Gundry, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

12819884-1206 Issued in UT

Practice address

115 Golf Course Rd Ste E
Logan, UT 84321-5934

Phone

(435) 999-4059

Fax

(435) 213-2800

NPI assigned

Aug 28, 2017

Last updated

Mar 28, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Martin Medical Group LLCGroup PAC ID 4284099177, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Martin Medical Group LLC

  dba Cache Ketamine and Mental Health

  • Physician Assistant
  • Logan, UT
  • NPI 1467081448
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1407373640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12002 N 5600 W",
            "city": "CORNISH",
            "state": "UT",
            "postal_code": "843081712",
            "telephone_number": "208-380-0251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GOLF COURSE RD STE E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215934",
            "telephone_number": "435-999-4059",
            "fax_number": "435-213-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDRY",
        "first_name": "GARRETT",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-28",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "12819884-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Groberg, PA
• Madison Rae Groberg
• Ethan J Groen, DMD
• Amber Christine Guerrero
• Guiding Light Mental Health and Wellness
• Miriam E Gunn, LMFT
• Chad Alden Gunnell
• Clayton Franklin Gunnell, DDS
• Emilie Gunnell, DNP
• Phillip Brown Gunnell, DO

• Medical Physician Assistant in Logan, UT
• Providers in Logan, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.