GRANGER MEDICAL DRAPER
NPI 1174968051
Family Medicine in Draper, UT

Q: What is Granger Medical Clinic PC's NPI number?

The NPI number for Granger Medical Clinic PC is 1174968051. It was assigned to this organization in the NPPES registry on May 6, 2013. The provider is also known as Granger Medical Draper.

Q: What is Granger Medical Clinic PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since May 06, 2013

11724 SOUTH STATE ST., DRAPER, UT 84020(801) 965-3600(801) 965-3740 Get Directions Write a Review

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

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About Granger Medical Draper NPPES

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

GRANGER MEDICAL DRAPER (NPI 1174968051) is a healthcare organization registered as a family medicine in Draper, Utah and active in the NPI registry since May 2013. The organization lists Mary Jane Pennington, President, as its authorized official.

NPPES Registry Identity

NPI1174968051

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameGRANGER MEDICAL CLINIC PC

Location Address11724 SOUTH STATE ST.Draper, UT 84020

Mailing Address2965 W 3500 SWest Valley City, UT 84119-3602 · (801) 965-3600

Phone(801) 965-3600

Fax(801) 965-3740

Organization SubpartYes

Authorized OfficialMary Jane PenningtonPresident · (801) 965-3600

Enumeration DateMay 6, 2013

Last NPPES UpdateDecember 13, 2023

NPPES CertifiedDecember 13, 2023

✔ NPI 1174968051 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedDermatologyTaxonomy 207N00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X

Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X

Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X

Also ListedInternal Medicine · Sports MedicineTaxonomy 207RS0010X

Also ListedInternal Medicine · Sleep MedicineTaxonomy 207RS0012X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedOphthalmologyTaxonomy 207W00000X

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

Also ListedOtolaryngologyTaxonomy 207Y00000X

Also ListedPediatricsTaxonomy 208000000X

Also ListedPlastic SurgeryTaxonomy 208200000X

Also ListedPain Medicine · Pain MedicineTaxonomy 208VP0000X

11724 SOUTH STATE ST., Draper, UT 84020

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Other Names 1

Other NameGranger Medical Draper

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 Draper 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 Draper, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 99 within 10 miles. 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

Lehai Austin, WHNP

Nurse Practitioner

NPI 1093469116

11724 S STATE ST
Draper, UT 84020

(801) 576-2050

✔ PECOS✔ Accepts MedicareSame address

Kimball Bailey, DO

Internal Medicine

NPI 1073176400

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOS✔ Accepts MedicareSame address

Melinda Midgley, MD

Family Practice

NPI 1760587653

11724 S STATE ST
Draper, UT 84020

(801) 576-2092

✔ PECOS✔ Accepts MedicareSame address

Jonathan Olsen, D.O.

Allergy/Immunology

NPI 1518287846

11724 S STATE ST
Draper, UT 84020

(801) 576-2000

✔ PECOS✔ Accepts MedicareSame address

Susan Prater, M.D.

Family Practice

NPI 1841430733

11724 SOUTH STATE ST STE 100
Draper, UT 84020

(801) 576-2065

✔ PECOS✔ Accepts MedicareSame address

Pinky Kotwal, MD

Internal Medicine

NPI 1083645444

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOS✔ Accepts MedicareSame address

Layne Smith, MD

Obstetrics/Gynecology

NPI 1770693251

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOS✔ Accepts MedicareSame address

Michael Twede, MD

Obstetrics/Gynecology

NPI 1861450140

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOS✔ Accepts MedicareSame address

Robert Williams, MD

Family Practice

NPI 1063596401

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOSSame address

Tyler Wood, DO

Internal Medicine

NPI 1962994962

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOS✔ Accepts Medicare0.1 mi

Melanie Riederer, FNP-C

Nurse Practitioner

NPI 1023823044

11724 S STATE ST
Draper, UT 84020

(801) 965-3600

✔ PECOS✔ Accepts Medicare0.1 mi

Roscoe Nelson, MD

Urology

NPI 1962487462

807 E PIONEER RD UNIT 105
Draper, UT 84020

(480) 686-5090

✔ PECOS✔ Accepts Medicare1.5 mi

Cori Anderson, NP

Nurse Practitioner

NPI 1255209284

9660 S 1300 E # 20
Sandy, UT 84094

(801) 965-3600

✔ PECOS2.0 mi

James Meadows, MD

Orthopedic Surgery

NPI 1285892968

9844 S 1300 E
Sandy, UT 84094

(801) 571-9433

✔ PECOS✔ Accepts Medicare2.5 mi

William Boam, MD

Family Practice

NPI 1659388791

12391 S 4000 W
Riverton, UT 84096

(801) 302-1700

✔ PECOS✔ Accepts Medicare2.7 mi

Craig Coleby, MD

Internal Medicine

NPI 1386825024

12391 S 4000 W SUITE 100
Riverton, UT 84096

(801) 302-1700

✔ PECOS✔ Accepts Medicare2.7 mi

Carly Davis, M.D.

Pediatric Medicine

NPI 1801121108

12391 S 4000 W
Riverton, UT 84096

(801) 302-1700

✔ PECOS✔ Accepts Medicare2.7 mi

Edwin England, DO

Obstetrics/Gynecology

NPI 1417068313

12391 S 4000 W
Riverton, UT 84096

(801) 302-1700

✔ PECOS✔ Accepts Medicare2.7 mi

Stephanie Henderson, MD

Gynecological Oncology

NPI 1982997284

9450 S 1300 E
Sandy, UT 84094

(801) 501-2160

✔ PECOS✔ Accepts Medicare3.7 mi

James Mcintyre, M.D.

Sports Medicine

NPI 1043446602

9844 S 1300 E STE 100
Sandy, UT 84094

(801) 965-3600

✔ PECOS✔ Accepts Medicare3.9 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.

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 1174968051. It was assigned to this organization in the NPPES registry on May 6, 2013. The provider is also known as Granger Medical Draper.

Where is Granger Medical Clinic PC located?

Granger Medical Clinic PC is located at 11724 South State St., Draper, UT 84020. The listed phone number is (801) 965-3600.

What is Granger Medical Clinic PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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, 5 practice at this address and 99 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.