JORDAN DIANE FORMAN (APRN) – Family Nurse Practitioner, NPI 1023661048
Family Nurse Practitioner
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
2,947 NURSE PRACTITIONER in NV
Provider Addresses for JORDAN DIANE FORMAN (APRN)
6110 Plumas St
Reno, NV 895196076
Phone: (775) 786-6880
Type: Location
1905 E 4th St
Reno, NV 895123789
Phone: (775) 786-4673
Fax: (775) 786-4673
Type: Location
Wells Avenue Medical/Dental Center, 1055, South Wells Avenue, Midtown, Reno, Washoe County, Nevada, 89502, United States
RENO, NV 895022550
Phone: (775) 329-6300
Fax: (775) 348-9896
Type: Mailing
580 W 5TH ST
RENO, NV 895034407
Phone: (775) 786-4673
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $120.
Total Amount is formed as General ($120) + Research ($0) + Ownership ($0) = $120.
Last reported payment date: 2024-09-25 • Largest payer in this snapshot: Merck Sharp & Dohme LLC ($37).
Total Amount
$120
General + Research + Ownership
Payments
7
Total payment records
General Amount
$120
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-25
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Merck Sharp & Dohme LLC | $37 |
| GlaxoSmithKline, LLC. | $32 |
| ABBVIE INC. | $22 |
| PFIZER INC. | $16 |
| Lilly USA, LLC | $13 |
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: 2019-10-31
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 |
|---|---|---|---|---|
| I20191031001197 | I | Nurse Practitioner | NV | 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 |
|---|---|---|---|---|
| 83036 | Hemoglobin a1c level | 42 | 19 | $0 |
| 82962 | Blood glucose (sugar) test performed by hand-held instrument | 40 | 19 | $0 |
Insurance plans in this area (ZIP 89519)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | WA | |
| Clinical Social Worker | NV | |
| Clinical Social Worker | NV | |
| Physician Assistant | NV | |
| Clinical Social Worker | NV | |
| Family Practice | NV | |
| P S Y C H I A T R Y | NV | |
| Nurse Practitioner | NV | |
| Infectious Disease, Internal Medicine | NV | |
| Infectious Disease | NV |
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