NPIMap

Individual provider Active NPI

Grant A Jolliffe, FNP

  • Family Nurse Practitioner
  • Medford, OR
National Provider Identifier
1699325092
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201903972NP-PP Issued in OR
Practice address
70 Bower Dr
Medford, OR 97501-3689
Phone
(541) 734-3430
Fax
(541) 734-3638
NPI assigned
Sep 17, 2019
Last updated
Mar 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201903972NP-PP OR Primary

Addresses

Primary practice location

70 Bower Dr
Medford, OR 97501-3689

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (541) 734-3430

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address gjolliffe523595@oc.providencedirect.org
Direct Messaging Address gjolliffe523595@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20191105001565 OR Practitioner - Nurse Practitioner 9739411133 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

70 Bower Dr
Medford, OR 97501-3689
Phone (541) 732-8300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
201903972NP-PPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2019 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2019 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2019 Accepting new patients
Providence Health & Services - Oregon CurrentSince Dec 1, 2019 Accepting new patients
Providence Health & Services - Oregon Past Accepting new patients

Locations

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

3225 Hillcrest Park Dr
Medford, OR 97504
Phone (541) 774-5700

70 Bower Dr
Medford, OR 97501
Phone (541) 732-3650

940 Royal Ave
Unit 350
Medford, OR 97504
Phone (541) 732-7460

Interoperability endpoints

  • Direct secure messaging: gjolliffe523595@oc.providencedirect.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1699325092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-734-3430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 BOWER DR",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975013689",
            "telephone_number": "541-734-3430",
            "fax_number": "541-734-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLIFFE",
        "first_name": "GRANT",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-17",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201903972NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gjolliffe523595@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "70 Bower Dr",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975013689",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gjolliffe523595@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "3225 Hillcrest Park Dr",
            "city": "Medford",
            "state": "OR",
            "country_code": "US",
            "postal_code": "975047657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.