Madison Rae Groberg

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-2019 Issued in ID

Practice address

115 Golf Course Rd Ste E
Logan, UT 84321-5934

Phone

(435) 999-4059

NPI assigned

Jul 1, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pearl Health ClinicGroup PAC ID 0840356077, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pearl Health Clinic

  • Mental Health Counselor
  • Ammon, ID
  • NPI 1447426465

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Anywhere Clinic LLC

  • Psychiatry Physician
  • Las Vegas, NV
  • NPI 1316460850

  ID, Single Specialty

  Medicare reassignment NPD
• Family Solutions Counseling

  • Clinical Social Worker
  • Logan, UT
  • NPI 1073034823

  Single Specialty

  NPD (past)
• Just 4 Kids Health LLC

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1043722259

  Single Specialty

  NPD (past)
• Just 4 Kids Home Health

  • Home Health Agency
  • Idaho Falls, ID
  • NPI 1396372041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1043837404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 GOLF COURSE RD STE E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GOLF COURSE RD STE E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215934",
            "telephone_number": "435-999-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROBERG",
        "first_name": "MADISON",
        "middle_name": "RAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-01",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-2019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Mapleton",
            "affiliation": "N",
            "address_1": "195 W 1200 N",
            "city": "Mapleton",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846643402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amalia Jean Gridley
• Jamie Len Griffin
• Aiena Laya Angeles Bautista Griffith, PT
• Crystal Grimes
• Christopher Groberg, PA
• Ethan J Groen, DMD
• Amber Christine Guerrero
• Guiding Light Mental Health and Wellness
• Garrett Ryan Gundry, PA-C
• Miriam E Gunn, LMFT

• Medical Physician Assistant in Logan, UT
• Providers in Logan, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.