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GRANGER MEDICAL CLINIC PC
NPI 1073811733
Clinic/Center - Multi-Specialty in Tooele, UT

Active since March 04, 2011CLIA Certified · 2 labs
2356 N 400 E STE 201, TOOELE, UT 84074(801) 352-5900(801) 352-5914 Get Directions Write a Review

NPPES record last updated: December 13, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Granger Medical Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRANGER MEDICAL CLINIC PC (NPI 1073811733) is a healthcare organization registered as a multi-specialty in Tooele, Utah and active in the NPI registry since March 2011. The organization holds 2 active CLIA laboratory certificates and lists Mary Jane Pennington, President, as its authorized official.

NPPES Registry Identity

NPI1073811733
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameGRANGER MEDICAL CLINIC PC
Location Address2356 N 400 E STE 201Tooele, UT 84074-3409
Mailing Address2965 W 3500 SWest Valley City, UT 84119-3602 · (801) 965-3600
Phone(801) 352-5900
Fax(801) 352-5914
Organization SubpartYes
Authorized OfficialMary Jane PenningtonPresident · (801) 965-3600
Enumeration DateMarch 4, 2011
Last NPPES UpdateDecember 13, 2023
NPPES CertifiedDecember 13, 2023
✔ NPI 1073811733 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
2356 N 400 E STE 201, Tooele, UT 84074
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Granger Medical Clinic Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

190

Medicare enrollment records show 190 clinicians reassign Medicare billing to Granger Medical Clinic PC, which bills Medicare for the services they deliver. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 32

Nurse Practitioner38
Family Practice34
Urology17
Internal Medicine16
Obstetrics/Gynecology13
Pediatric Medicine9
Diagnostic Radiology7
Orthopedic Surgery6
24 other specialties50

Nearest to this location (20)

See all 190
Marshall Nickel, MD
Family Practice
NPI 1134357239
3181 W 9000 S BLDG A, SUITE 100
West Jordan, UT 84088
(801) 352-5900
✔ PECOS✔ Accepts Medicare14 mi
Logan Sanderson, FNP-C
Nurse Practitioner
NPI 1316768534
3181 W 9000 S
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare14 mi
Sandeep Chowdhary, MD
Pulmonary Disease
NPI 1891726162
3181 W 9000 SO
West Jordan, UT 84088
(801) 352-5900
✔ PECOS✔ Accepts Medicare16 mi
Monica Hinz, DO
Pediatric Medicine
NPI 1669977880
4745 S 3200 W
Taylorsville, UT 84129
(801) 964-6214
✔ PECOS16 mi
Justin Banks, DPM, MHA
Podiatry
NPI 1356726749
3181 W 9000 S
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare17 mi
Catherine Beck, MD
General Surgery
NPI 1922267459
3181 W 9000 S
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare17 mi
Alton Burgett, MD
Obstetrics/Gynecology
NPI 1124059514
3181 W 9000 S
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare17 mi
Brandon Childs, MD
Urology
NPI 1659721199
3181 W 9000 S
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare17 mi
Alexander Nicholson, MD
Allergy/Immunology
NPI 1497188197
3181 W 9000 S
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare17 mi
Ashleigh Byrne, MD
Pain Management
NPI 1023269537
9001 S 3200 W
West Jordan, UT 84088
(801) 965-3600
✔ PECOS✔ Accepts Medicare17 mi
Douglas Heiner, MD
Dermatology
NPI 1366753865
9001 S 3200 W
West Jordan, UT 84088
(801) 965-2799
✔ PECOS✔ Accepts Medicare17 mi
Jon Aoki, M.D.
Otolaryngology
NPI 1295805265
3725 W 4100 S
West Valley City, UT 84120
(801) 965-3484
✔ PECOS18 mi
Craig Coleby, MD
Internal Medicine
NPI 1386825024
12391 S 4000 W SUITE 100
Riverton, UT 84096
(801) 302-1700
✔ PECOS✔ Accepts Medicare18 mi
Andrew Fedoravicius, MD
Gastroenterology
NPI 1851585087
2965 W 3500 S
West Valley City, UT 84119
(801) 965-3600
✔ PECOS✔ Accepts Medicare18 mi
Michelle Looye, LCSW
Clinical Social Worker
NPI 1639554199
2965 W 3500 S
West Valley City, UT 84119
(801) 965-3600
✔ PECOS18 mi
Mark Nevers, OD
Optometry
NPI 1366704959
2965 W 3500 S
West Valley City, UT 84119
(801) 965-3600
✔ PECOS✔ Accepts Medicare18 mi
Komal Rastogi, MD
Neurology
NPI 1063774669
2965 W 3500 S
West Valley City, UT 84119
(801) 965-3600
✔ PECOS✔ Accepts Medicare18 mi
Daniel Richards, DO
Orthopedic Surgery
NPI 1649455403
2965 W 3500 S
West Valley City, UT 84119
(801) 965-3600
✔ PECOS✔ Accepts Medicare18 mi
Robert Smith, MD
Ophthalmology
NPI 1578675633
2965 W 3500 S
West Valley City, UT 84119
(801) 965-3600
✔ PECOS✔ Accepts Medicare18 mi
James Mcintyre, M.D.
Sports Medicine
NPI 1043446602
9844 S 1300 E STE 100
Sandy, UT 84094
(801) 965-3600
✔ PECOS✔ Accepts Medicare21 mi
See all 190 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 46D2157488

Granger Medical Fairbourne · West Valley City, UT
Active · expires Mar 20, 2028
CLIA Number46D2157488
Laboratory TypePhysician Office
Certificate Effective DateMarch 21, 2026
Certificate Expiration DateMarch 20, 2028
Laboratory DirectorSean D. Peterson
Laboratory Phone(801) 965-3600
Laboratory LocationGranger Medical Fairbourne2965 W 3500 S, West Valley City, UT 84119
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 46D2124743

Granger Medical Clinic Tooele · Tooele, UT
Active · expires Jan 23, 2027
CLIA Number46D2124743
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorCorey Neerings
Laboratory Phone(435) 843-4406
Laboratory LocationGranger Medical Clinic Tooele2326 N 400 E Bldg C, Suite 203, Tooele, UT 84074
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Granger Medical Clinic PC's NPI number?

The NPI number for Granger Medical Clinic PC is 1073811733. It was assigned to this organization in the NPPES registry on March 4, 2011.

Where is Granger Medical Clinic PC located?

Granger Medical Clinic PC is located at 2356 N 400 E Ste 201, Tooele, UT 84074. The listed phone number is (801) 352-5900.

What is Granger Medical Clinic PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Is Granger Medical Clinic PC enrolled in Medicare?

Yes. Granger Medical Clinic PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Granger Medical Clinic PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 190 clinicians in 32 Medicare specialties reassign their Medicare billing to Granger Medical Clinic PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (38), Family Practice (34) and Urology (17). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Granger Medical Clinic PC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Granger Medical Clinic PC was last updated on December 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.