Active NPI
Jordan J Grooms, PA-C
- Physician Assistant
- Kearney, NE
National Provider Identifier
1124704879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3205
- Practice address
- 2810 W 35TH St Ste 1
Kearney, NE 68845-2909 - Phone
- (308) 865-2570
- Fax
- (308) 865-2508
- NPI assigned
- Jun 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3205 | NE | Primary |
Addresses
Primary practice location
2810 W 35TH St Ste 1
Kearney, NE 68845-2909
Mailing address
2810 W 35TH St Ste 1
Kearney, NE 68845-2909
Phone (308) 865-2570
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250206000911 | NE | Practitioner - Physician Assistant | 7911437942 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3205 | NE | MD | Physician Assistant |
Organizations & group practices 6
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.
-
- Rural Health Clinic/Center
- Arapahoe, NE
- NPI 1053408583
-
- Rural Health Clinic/Center
- Indianola, NE
- NPI 1316034846
-
- Critical Access Hospital
- Cambridge, NE
- NPI 1821161043
-
- Rural Health Clinic/Center
- Cambridge, NE
- NPI 1871680306
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cambridge Memorial Hospital Inc
Practice addresses (Care Compare)
PO Box
Suite 488
Cambridge, NE 69022
Hospital & facility affiliations
- Tri Valley Health System
- Kearney Regional Medical Center
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738281600000",
"number": "1124704879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 W 35TH ST STE 1",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688452909",
"telephone_number": "308-865-2570",
"fax_number": "308-865-2508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2810 W 35TH ST STE 1",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688452909",
"telephone_number": "308-865-2570",
"fax_number": "308-865-2508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOMS",
"first_name": "JORDAN",
"middle_name": "J",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-27",
"last_updated": "2025-01-31",
"certification_date": "2025-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "3205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; 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.