Ethan D. Granger
NPI 1457048324ActiveIndividual· Physician Assistant· La Jolla, CA
Physician Assistant with Regents of the University of California, practicing in La Jolla, California. Enrolled in Medicare as practitioner - physician assistant and practitioner - physician assistant.
Overview
| NPI | 1457048324 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Apr 20, 2023 |
| Last updated in NPPES | Jan 28, 2026 |
| Certified by provider | Jan 28, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | PA67139 | CA |
| Physician Assistant | 363A00000X | PA2024-0038 | NM |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (CA); Practitioner - Physician Assistant (NM) |
|---|
Education and affiliations
| Graduation year | 2024 |
|---|---|
| Medicare specialty | Physician Assistant |
Medical group
- Regents of the University of CaliforniaSan Diego, CA · 2,089 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
Other physician assistants in La Jolla
- 1043833163
- 1053180794
- 1053429621
- 1053643189
- 1053745059
- 1053913541
- 1063784478
- 1063870723
- 1073886289
- 1104998541
- 1114652005
- 1144701616
All 149 physician assistants in La Jolla · All physician assistants in California