JACOB ALEXANDER GROEN (DO) – Psychiatry Physician, NPI 1184248841

JACOB ALEXANDER GROEN (DO) is a healthcare provider. based in Shoreline, Washington. specializing in FAMILY PRACTICE, PSYCHIATRY. They hold the professional credentials DO. They hold a License No. R-11870 (IA). The NPI Number for JACOB ALEXANDER GROEN (DO) is 1184248841

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
JACOB ALEXANDER GROEN (DO)
NPI
1184248841
Phone
(206) 947-6169
Address
15811 3RD AVE NE
Enumeration Date
29 May 2020
Last Update Date
29 May 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5095758000
Graduation Year
2020 (6 years ago)
PAC ID
3173946076
Group Practice PAC ID
1557391596
Professional Enrollment ID
I20250919002750
Address ID
WA989023761YA2811XDRXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness75
Years active:6State licenses:1Digital endpointsOther names

1,656 FAMILY PRACTICE in IA

Provider Addresses for JACOB ALEXANDER GROEN (DO)

  • 15811 3RD AVE NE

    SHORELINE, WA 981555718

    Phone: (206) 947-6169

    Type: Mailing

  • 200 HAWKINS DR

    IOWA CITY, IA 522421009

    Phone: (319) 384-7222

    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: 2025-09-19

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
I20250919002750IFamily PracticeWATBD

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 98155)

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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: 1557391596View full group profile
NameSpecialtyState
Emergency MedicineWA
Internal MedicineNJ
Certified Registered Nurse Anesthetist (Crna)WA
Certified Registered Nurse Anesthetist (Crna)WA
-WA
Internal MedicineWA
Emergency MedicineWA
-WA
Family PracticeWA
H E M A T O L O G Y/ O N C O L O G YWI

Reviews

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Frequently asked questions

How do payers reference JACOB ALEXANDER GROEN (DO)?
For JACOB ALEXANDER GROEN (DO), use NPI 1184248841 as the unique 10-digit identifier.
Active or inactive — what applies to JACOB ALEXANDER GROEN (DO)?
You should see JACOB ALEXANDER GROEN (DO) as active in CMS-hosted NPPES data.
What clinical focus is listed for JACOB ALEXANDER GROEN (DO)?
At a glance, JACOB ALEXANDER GROEN (DO) is tied to Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Is JACOB ALEXANDER GROEN (DO) associated with Shoreline?
Public fields place JACOB ALEXANDER GROEN (DO) around Shoreline, Washington. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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