JORDAN J GROOMS (PA-C) – Physician Assistant, NPI 1124704879

JORDAN J GROOMS (PA-C) is a healthcare provider. based in Kearney, Nebraska. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. 3205 (NE). The NPI Number for JORDAN J GROOMS (PA-C) is 1124704879

Main info

Male
2 Years Of Experience
Accepts Medicare Assignment
Name
JORDAN J GROOMS (PA-C)
NPI
1124704879
Phone
(308) 865-2570
Address
2810 W 35TH ST STE 1
Enumeration Date
27 June 2023
Last Update Date
31 January 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3088652570
Graduation Year
2024 (2 years ago)
PAC ID
7911437942
Group Practice PAC ID
6800861014
Professional Enrollment ID
I20250206000911
Address ID
NE688452909KE2810XSTXX402
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

1,397 PHYSICIAN ASSISTANT in NE

Provider Addresses for JORDAN J GROOMS (PA-C)

  • 2810 W 35TH ST STE 1

    KEARNEY, NE 688452909

    Phone: (308) 865-2570

    Fax: (308) 865-2508

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $16.

Total Amount is formed as General ($16) + Research ($0) + Ownership ($0) = $16.

Last reported payment date: 2024-10-23 • Largest payer in this snapshot: UCB, Inc. ($16).

Total Amount

$16

General + Research + Ownership

Payments

1

Total payment records

General Amount

$16

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-23

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
UCB, Inc.$16
View all Open Payments →|Open Payments Risk Radar →

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: 2025-02-06

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
I20250206000911IPhysician AssistantNETBD

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 68845)

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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: 6800861014View full group profile
NameSpecialtyState
Physician AssistantNE
Hand Surgery, Orthopedic SurgeryNE
Orthopedic SurgeryNE
Physician AssistantNE
Physician AssistantNE
Physician AssistantNE
-NE
Physician AssistantNE
Physician AssistantMO
Sports Medicine, Orthopedic SurgeryNE

Reviews

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Frequently asked questions

What number should I use to identify JORDAN J GROOMS (PA-C) for billing?
Administrative and clinical systems typically use NPI 1124704879 for JORDAN J GROOMS (PA-C).
Should I treat JORDAN J GROOMS (PA-C) as an active provider?
Patients and plans typically see JORDAN J GROOMS (PA-C) as active in the national extract.
What services align with JORDAN J GROOMS (PA-C)'s listing?
JORDAN J GROOMS (PA-C)'s public classification highlights Physician Assistant. Clinical services aligned with this taxonomy classification.
What geographic area is tied to JORDAN J GROOMS (PA-C)?
JORDAN J GROOMS (PA-C) is associated with Kearney, Nebraska in the same public data insurers reference.
Can I export JORDAN J GROOMS (PA-C)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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