Active NPI
Jonathan Ivan Granados
- Physician Assistant
- Santa Maria, CA
National Provider Identifier
1871376582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 430 S Blosser Rd
Santa Maria, CA 93458-4908 - Phone
- (053) 618-9008
- Fax
- (805) 361-8990
- NPI assigned
- Aug 16, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | CA | Primary |
Addresses
Primary practice location
430 S Blosser Rd
Santa Maria, CA 93458-4908
Mailing address
2050 S Blosser Rd
Santa Maria, CA 93458-7310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240227000031 | CA | Order and Referring Only - Physician Assistant | 6507201894 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- jonathan.granados.1@17363.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1871376582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 S BLOSSER RD",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934587310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 S BLOSSER RD",
"city": "SANTA MARIA",
"state": "CA",
"postal_code": "934584908",
"telephone_number": "053-618-9008",
"fax_number": "805-361-8990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANADOS",
"first_name": "JONATHAN",
"middle_name": "IVAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-16",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Maria, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.