KELLY ELIZABETH JACKSON PT, DPT
NPI 1053830968
Physical Therapist - Orthopedic in Clackamas, OR
About Kelly Elizabeth Jackson Pt, Dpt NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY ELIZABETH JACKSON PT, DPT (NPI 1053830968) is an individual orthopedic provider in Clackamas, Oregon, licensed in Oregon (62508) and active in the NPI registry since September 2017. She is a graduate of Other (2017).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kelly Elizabeth Jackson Pt, Dpt is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
3Medicare enrollment records show Kelly Jackson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Clackamas, OR 97015
- Reassigned Medicare billing, Oregon and Washington enrollments
- Also billed through NPI 1871848457 (Washington)
- 3,207 clinicians in this Medicare group
Lake Oswego, OR 97034
- Reassigned Medicare billing, Oregon enrollment
- 48 clinicians in this Medicare group
Hillsboro, OR 97124
- Reassigned Medicare billing, Oregon enrollment
- 79 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CLACKAMAS, OR 97015
CLACKAMAS, OR 97015
CLACKAMAS, OR 97015
CLACKAMAS, OR 97015
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Jackson's NPI number?
The NPI number for Kelly Jackson is 1053830968. It was assigned to this individual provider in the NPPES registry on September 12, 2017.
Where is Kelly Jackson located?
Kelly Jackson practices at 10100 SE Sunnyside Rd, Clackamas, OR 97015. The listed phone number is (503) 813-2000.
What is Kelly Jackson's specialty?
The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.
Is Kelly Jackson enrolled in Medicare?
Yes. Kelly Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kelly Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Jackson reassigns Medicare benefits to 3 organizations: Kaiser Foundation Health Plan Of The Northwest (Clackamas, OR), North Lake Physical Therapy And Rehab LP (Lake Oswego, OR) and Oregon Luna Care Physical Therapy LLC (Hillsboro, OR). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Jackson was last updated on March 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kelly Elizabeth Jackson, PT, DPT · NPI 1053830968
Orthopedic provider in Clackamas, Oregon. Individual provider, active in the CMS NPPES registry since September 12, 2017.
## Identity
- **NPI:** 1053830968 (Entity type: Individual)
- **Enumerated:** September 12, 2017
- **Primary specialty:** Physical Therapist - Orthopedic · taxonomy 2251X0800X
- **State license:** 62508 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 10100 SE SUNNYSIDE RD, Clackamas, OR 97015-8970
- **Phone:** (503) 813-2000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Kaiser Foundation Health Plan Of The Northwest (NPI 1174851505, Clackamas, OR); North Lake Physical Therapy And Rehab LP (NPI 1316383201, Lake Oswego, OR); Oregon Luna Care Physical Therapy LLC (NPI 1891397121, Hillsboro, OR) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2017
## Record status
- **NPPES last updated:** March 5, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1053830968) · Data from the CMS NPPES public registry.