NPIMap

Organization Active NPI

Granger Medical Clinic, PC

Doing business as Granger Medical Cottonwood Sleep Center

  • Sleep Medicine (Internal Medicine) Physician
  • Murray, UT
National Provider Identifier
1447609987
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
Legal business name
GRANGER MEDICAL CLINIC, PC
Doing business as
Granger Medical Cottonwood Sleep Center
Practice address
5801 S Fashion Blvd
Suite 140
Murray, UT 84107
Phone
(801) 260-5864
Fax
(801) 260-5865
NPI assigned
Jun 6, 2016
Last updated
Jul 30, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GRANGER MEDICAL CLINIC, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Mary Jane PenningtonNPI 1205868452
Title
President
Phone
(801) 965-3600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician 207RS0012X NU Primary

Addresses

Primary practice location

5801 S Fashion Blvd
Suite 140
Murray, UT 84107

Mailing address

7181 S Campus View Dr
West Jordan, UT 84084-4312
Phone (801) 965-3505

Other names 1

  • Granger Medical Cottonwood Sleep Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000159 UT Part B Supplier - Clinic/Group Practice 3476465691 Receives reassigned benefits from 239 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT; Sandy, UT; Tooele, UT; West Jordan, UT; West Valley City, UT; Draper, UT; American Fork, UT; Bountiful, UT…

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Granger Medical Clinica7 organizations share this tax ID, including this one
Part of
Granger Medical Clinica

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5801 S Fashion Blvd
Ste 140
Murray, UT 84107
Phone (801) 260-5864

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1447609987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7181 S CAMPUS VIEW DR",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840844312",
            "telephone_number": "801-965-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 S FASHION BLVD",
            "address_2": "SUITE 140",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "801-260-5864",
            "fax_number": "801-260-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER MEDICAL CLINIC, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANGER MEDICAL CLINIC, PC",
        "enumeration_date": "2016-06-06",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "MARY JANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-965-3600"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granger Medical Cottonwood Sleep Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.