GRANGER MEDICAL CLINIC PC
NPI 1104857549
Clinic/Center - Multi-Specialty in West Jordan, UT
About Granger Medical Clinic Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRANGER MEDICAL CLINIC PC (NPI 1104857549), doing business as Granger Medical West Jordan, is a healthcare organization registered as a multi-specialty in West Jordan, Utah and active in the NPI registry since July 2006. The organization holds 3 active CLIA laboratory certificates and lists Mary Jane Pennington, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
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
190Medicare enrollment records show 190 clinicians reassign Medicare billing to Granger Medical Clinic PC, which bills Medicare for the services they deliver. Of these, 19 practice at this address and 152 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 32
Nearest to this location (20)
See all 190Source: 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 3
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) 46D0669065
Granger Medical West Jordan Clinic · West Jordan, UTCertificate of Compliance 46D2013546
Granger Medical Clinic Dermatology · West Jordan, UTCertificate of Waiver 46D2316064
Granger Medical Clinic Pain And Spine, West Jordan · West Jordan, UTFrequently 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 1104857549. It was assigned to this organization in the NPPES registry on July 5, 2006. The provider is doing business as Granger Medical West Jordan.
Where is Granger Medical Clinic PC located?
Granger Medical Clinic PC is located at 3181 W 9000 So, West Jordan, UT 84088. 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). Of these, 19 practice at this address and 152 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Granger Medical Clinic PC hold CLIA laboratory certificates?
Yes. 3 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 September 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months 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.
# Granger Medical Clinic Pc · NPI 1104857549
Multi-Specialty organization in West Jordan, Utah. Organization record, active in the CMS NPPES registry since July 5, 2006.
## Identity
- **NPI:** 1104857549 (Entity type: Organization)
- **Enumerated:** July 5, 2006
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Also known as:** Granger Medical West Jordan (Doing Business As)
- **Organization subpart:** Yes (part of Granger Medical Clinic Pc)
- **Authorized official:** Mary Jane Pennington, PRESIDENT
## Practice location
- **Address:** 3181 W 9000 SO, West Jordan, UT 84088
- **Phone:** (801) 352-5900 · **Fax:** (801) 352-5914
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 190 clinicians in 32 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (38), Family Practice (34), Urology (17); 19 practice at this address and 152 within 10 miles; [full list](https://npiprofile.com/npi/1104857549/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 2, 2025
- **CLIA laboratory certificates:** 3 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104857549) · Data from the CMS NPPES public registry.