NPIMap

Organization Active NPI

Granger Medical Park City

  • Multi-Specialty Clinic/Center
  • West Jordan, UT
National Provider Identifier
1699050823
Registry record updated May 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GRANGER MEDICAL PARK CITY
Practice address
3181 W 9000 So
West Jordan, UT 84088
Phone
(801) 569-5520
Fax
(801) 352-5951
NPI assigned
Oct 19, 2011
Last updated
May 13, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
GRANGER MEDICAL CLINIC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2013

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

Authorized official

Name
Mrs. Mary Jane Pennington, MD
Title
President
Phone
(801) 965-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3181 W 9000 So
West Jordan, UT 84088

Mailing address

1600 Snow Creek Dr Ste B
Park City, UT 84060-7372
Phone (801) 569-5520

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
Part of
Granger Surgical Assoc

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368403200000",
    "number": "1699050823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SNOW CREEK DR STE B",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607372",
            "telephone_number": "801-569-5520",
            "fax_number": "801-352-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 W 9000 SO",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "84088",
            "telephone_number": "801-569-5520",
            "fax_number": "801-352-5951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER MEDICAL PARK CITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANGER MEDICAL CLINIC INC",
        "enumeration_date": "2011-10-19",
        "last_updated": "2013-05-13",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-965-3600",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2013; 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.