NPIMap

Individual provider Active NPI

Stephanie A. Granvall, P.A.-C

  • Surgical Physician Assistant
  • Issaquah, WA
National Provider Identifier
1861477960
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA60321925 Issued in WA
Practice address
751 NE Blakely Dr
Suite 4020
Issaquah, WA 98029-6201
Phone
(425) 313-7124
Fax
(425) 313-7057
NPI assigned
Dec 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA60321925 WA Primary

Addresses

Primary practice location

751 NE Blakely Dr
Suite 4020
Issaquah, WA 98029-6201

Mailing address

PO Box 25608
Salt Lake City, UT 84125-0608
Phone (206) 320-4476

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sgranvall1041775@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20130220000351 WA Practitioner - Physician Assistant 1557333994 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedish Health ServicesGroup PAC ID 0244138196, 1,038 clinicians

Practice addresses (Care Compare)

747 Broadway
Seattle, WA 98122-4379
Phone (206) 386-6000

751 NE Blakely Dr
Issaquah, WA 98029-6201

Hospital & facility affiliations

  • Swedish Issaquah Hospital, Issaquah, WA, CCN 500152

Merit-based Incentive Payment System (MIPS)

Final score
87.1 of 100Reported as group
Quality
84.53
Promoting interoperability
100
Improvement activities
40
Cost
72.46

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiovascular Consultants of the Cascades LLP Past Accepting new patients
Swedish Health Services Past Accepting new patients
Advanced Surgical Care, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sgranvall1041775@wm.providencedirect.org

Organizations & group practices 4

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 1

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": "1134345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1861477960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 NE BLAKELY DR",
            "address_2": "SUITE 4020",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980296201",
            "telephone_number": "425-313-7124",
            "fax_number": "425-313-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANVALL",
        "first_name": "STEPHANIE",
        "middle_name": "A.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-12",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA60321925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgranvall1041775@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "751 NE Blakely Dr",
            "address_2": "Suite 4020",
            "city": "Issaquah",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980296201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

Verify at the official NPI Registry.