MR. JARED L BROCK (PA) – Physician Assistant, NPI 1073551248
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for MR. JARED L BROCK (PA)
4001 W GOELLER BLVD STE A
COLUMBUS, IN 472018309
Phone: (812) 375-3330
Fax: (812) 375-3329
Type: Location
Music Box Theatre, 3733, North Southport Avenue, Wrigleyville, Lake View, Lakeview, Chicago, Lake View Township, Cook County, Illinois, 60613, United States
CHICAGO, IL 606775383
Phone: (812) 376-5315
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 94 Open Payments records for all available years, with a total value of $1,497.
Total Amount is formed as General ($1,497) + Research ($0) + Ownership ($0) = $1,497.
Last reported payment date: 2024-12-04 • Largest payer in this snapshot: ABBVIE INC. ($287).
Total Amount
$1,497
General + Research + Ownership
Payments
94
Total payment records
General Amount
$1,497
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $287 |
| GlaxoSmithKline, LLC. | $194 |
| Novo Nordisk Inc | $144 |
| IDORSIA PHARMACEUTICALS US INC | $60 |
| Otsuka America Pharmaceutical, Inc. | $59 |
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: 2005-02-18
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050218000378 | I | Physician Assistant | IN | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 36415 | Insertion of needle into vein for collection of blood sample | 322 | 207 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 289 | 196 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 207 | 138 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 152 | 152 | $0 |
| G0008 | Administration of influenza virus vaccine | 94 | 91 | $0 |
Insurance plans in this area (ZIP 47201)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | IN | 90670 | Pneumococcal vaccine for injection into muscle | 58 | 58 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IL | |
| Family Practice | IL | |
| N E U R O L O G Y | FL | |
| Nurse Practitioner | IN | |
| Nurse Practitioner | IL | |
| Family Practice | IN | |
| Family Practice | IN | |
| Physician Assistant | IL | |
| Nurse Practitioner | IN | |
| O B S T E T R I C S/ G Y N E C O L O G Y | IN |
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