NPIMap

Organization Active NPI

Granger Medical Clinic, PC

Doing business as Granger Medical Clinic - Millcreek Allergy

  • Specialist
  • Salt Lake City, UT
National Provider Identifier
1932216652
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1773041205 Issued in UT
Legal business name
GRANGER MEDICAL CLINIC, PC
Doing business as
Granger Medical Clinic - Millcreek Allergy
Practice address
1121 E 3900 S
Suite #C130
Salt Lake City, UT 84124-1214
Phone
(801) 281-1300
NPI assigned
Aug 25, 2006
Last updated
Jan 21, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
GRANGER MEDICAL CLINIC, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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

Authorized official

Name
Anne Whitaker
Title
Credentialing Coordinator
Phone
(801) 965-3505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 1773041205 UT Primary

Addresses

Primary practice location

1121 E 3900 S
Suite #C130
Salt Lake City, UT 84124-1214

Mailing address

1121 E 3900 S
Suite #C130
Salt Lake City, UT 84124-1214
Phone (801) 281-1300

Other names 1

  • Granger Medical Clinic - Millcreek Allergy Doing business as

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

Locations

1121 E 3900 S
Ste C130
Salt Lake Cty, UT 84124
Phone (801) 281-1300

Practitioners & affiliated clinicians

Practitioners 10

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": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1932216652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 E 3900 S",
            "address_2": "SUITE #C130",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241214",
            "telephone_number": "801-281-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 E 3900 S",
            "address_2": "SUITE #C130",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241214",
            "telephone_number": "801-281-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER MEDICAL CLINIC, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANGER MEDICAL CLINIC, PC",
        "enumeration_date": "2006-08-25",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "801-965-3505"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": "1773041205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Granger Medical Clinic - Millcreek Allergy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.