NPIMap

Individual provider Active NPI

Jonathan Rudy Brown, PA-C

  • Surgical Physician Assistant
  • American Fork, UT
National Provider Identifier
1598235798
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10986764-1206 Issued in UT
Practice address
1159 E 200 N Ste 300
American Fork, UT 84003-2037
Phone
(801) 965-3600
NPI assigned
Nov 29, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10986764-1206 UT
Surgical Physician Assistant 363AS0400X 10986764-1206 UT Primary

Addresses

Primary practice location

1159 E 200 N Ste 300
American Fork, UT 84003-2037

Mailing address

2965 W 3500 S
West Valley City, UT 84119-3602
Phone (801) 965-3600

Other practice location 1

555 W Sr 164
Salem, UT 84653
Phone (801) 465-4896

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190415000484 UT Practitioner - Physician Assistant 1557602802 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians

Practice addresses (Care Compare)

1159 E 200
Suite 300
American Fork, UT 84003-2037
Phone (801) 756-7609

12391 S 4000
Riverton, UT 84096-7012
Phone (801) 302-1700

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10986764-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Specialists, LLC CurrentSince Dec 1, 2020 Accepting new patients
Granger Medical Clinic PC CurrentSince Jan 6, 2024 Accepting new patients
Granger Medical Clinic Inc Internal Medicine CurrentSince Jan 6, 2024 Accepting new patients

Locations

1159 E 200 N
Ste 300
American Fork, UT 84003
Phone (801) 357-7530

3000 N Triumph Blvd
Ste 340
Lehi, UT 84043
Phone (435) 833-9180

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

995 W Levoy Dr
Taylorsville, UT 84123

7181 S Campus View Dr
Ste 200
West Jordan, UT 84084
Phone (801) 965-3505

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3545

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Organizations & group practices 6

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1598235798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 W 3500 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193602",
            "telephone_number": "801-965-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 E 200 N STE 300",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032037",
            "telephone_number": "801-965-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 W SR 164",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "UT",
            "postal_code": "84653",
            "country_code": "US",
            "telephone_number": "801-465-4896",
            "fax_number": "801-465-3267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JONATHAN",
        "middle_name": "RUDY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-29",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10986764-1206",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "10986764-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in American Fork, UT

Sources for this page

Verify at the official NPI Registry.