GILLIAN GRANNUM (PHD) – Clinical Psychologist, NPI 1407292162

GILLIAN GRANNUM (PHD) is a healthcare provider. based in Ephrata, Pennsylvania. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PHD. They hold a License No. PS018690 (PA). The NPI Number for GILLIAN GRANNUM (PHD) is 1407292162

Main info

Female
9 Years Of Experience
Accepts Medicare Assignment
Name
GILLIAN GRANNUM (PHD)
NPI
1407292162
Phone
(717) 733-0311
Address
169 Martin Ave
Enumeration Date
21 May 2013
Last Update Date
16 September 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7177381125
Graduation Year
2017 (9 years ago)
PAC ID
1355686437
Group Practice PAC ID
8729991419
Professional Enrollment ID
I20181218001127
Address ID
PA175221651EP344XXRDXX400
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness75
Years active:13State licenses:1Digital endpointsOther names

1,669 CLINICAL PSYCHOLOGIST in PA

Provider Addresses for GILLIAN GRANNUM (PHD)

  • 169 Martin Ave

    Ephrata, PA 175221724

    Phone: (717) 733-0311

    Fax: (717) 738-6735

    Type: Location

  • 69 WESTPOINTE DR

    EPHRATA, PA 175222488

    Phone: (267) 934-1940

    Type: Mailing

  • 354 N READING RD

    EPHRATA, PA 175221651

    Phone: (267) 934-1940

    Type: Location

  • 601 MEMORY LN

    YORK, PA 174022231

    Phone: (717) 851-1405

    Fax: (717) 851-6969

    Type: Mailing

  • 344 N READING RD

    EPHRATA, PA 175221651

    Phone: (717) 738-1125

    Fax: (717) 738-0606

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-12-18

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20181218001127IClinical PsychologistPATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 17522)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8729991419View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for GILLIAN GRANNUM (PHD)?
GILLIAN GRANNUM (PHD) — NPI 1407292162 — is the standard way to identify this listing.
Can I rely on GILLIAN GRANNUM (PHD) being an active provider?
As of the registry snapshot, GILLIAN GRANNUM (PHD) is marked active.
What is GILLIAN GRANNUM (PHD)'s primary classification?
Clinical Psychologist is the headline specialty for GILLIAN GRANNUM (PHD) here. Clinical services aligned with this taxonomy classification.
Where is GILLIAN GRANNUM (PHD) based?
GILLIAN GRANNUM (PHD) is tied to Ephrata, Pennsylvania in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
5 practice locations appear in the available data.

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