DR. KENNETH DOUGLAS JACKSON M.D.
NPI 1073510491
Family Medicine in Kingman, AZ

Q: What is Kenneth Jackson's NPI number?

The NPI number for Kenneth Jackson is 1073510491. It was assigned to this individual provider in the NPPES registry on June 30, 2005.

Q: What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since June 30, 2005PECOS EnrolledAccepts Medicare Assignment

83.2/100

CMS Quality Rating

1739 E BEVERLY AVE, SUITE 201, KINGMAN, AZ 86401(928) 692-3456(928) 692-7071 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 13, 2026, Mar 7, 2023 (2 updates tracked since 2023).

On this page

About Dr. Kenneth Douglas Jackson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KENNETH DOUGLAS JACKSON M.D. (NPI 1073510491) is an individual family medicine provider in Kingman, Arizona, licensed in Arizona (12522) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS and is a graduate of Baylor College Of Medicine (1974).

NPPES Registry Identity

NPI1073510491

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. KENNETH DOUGLAS JACKSONCredential: M.D.

Location Address1739 E BEVERLY AVE, SUITE 201Kingman, AZ 86401-3593

Mailing Address1739 E Beverly Ave, Suite 201Kingman, AZ 86401-3593 · (928) 692-3456 · Fax (928) 692-7071

Phone(928) 692-3456

Fax(928) 692-7071

Sole ProprietorNo

Medical School CMSBaylor College Of MedicineGraduated 1974

Enumeration DateJune 30, 2005

Last NPPES UpdateJuly 13, 20262 updates tracked since enumeration

✔ NPI 1073510491 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in AZ · 12522

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1739 E BEVERLY AVE, Kingman, AZ 86401

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Other Identifiers 2

Medicaid209991AZ

Other12522AZ · License

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

Dr. Kenneth Douglas Jackson M.d. 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.

PECOS PAC ID9133146343

PECOS Enrollment IDI20051027000503

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kenneth Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Kingman Healthcare, Inc

Same address

Specialist

1739 E BEVERLY AVE
Kingman, AZ 86409

Reassigned Medicare billing, Arizona enrollment
418 clinicians in this Medicare group

NPI 1689897787 (928) 263-4547

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 86401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$98.00 typical visit price

range $17.72 – $137.41

Typical copayment $24.50 (range $4.43 – $34.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.2/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

87.73

Promoting Interoperability

Improvement Activities

Cost

71.28

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TONY JOSEPH LEMANSKI M.D.

Obstetrics & Gynecology

1739 E BEVERLY AVE, SUITE 201
KINGMAN, AZ 86401

Mohave County (928) 692-3456

DR. JOSEPH HENRY TEDESCO D.O.

Obstetrics & Gynecology

1739 E BEVERLY AVE, SUITE 201
KINGMAN, AZ 86401

Mohave County (928) 692-3456

DR. LORNE FRANKLIN TAYLOR D.O.

Obstetrics & Gynecology

1739 E BEVERLY AVE, STE 201
KINGMAN, AZ 86401

Mohave County (928) 692-3456

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 Kenneth Jackson's NPI number?

The NPI number for Kenneth Jackson is 1073510491. It was assigned to this individual provider in the NPPES registry on June 30, 2005.

Where is Kenneth Jackson located?

Kenneth Jackson practices at 1739 E Beverly Ave Suite 201, Kingman, AZ 86401. The listed phone number is (928) 692-3456.

What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Kenneth Jackson enrolled in Medicare?

Yes. Kenneth 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 organization bills Medicare for Kenneth Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Jackson reassigns Medicare benefits to Kingman Healthcare, Inc (Kingman, AZ). The 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 Kenneth 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 Kenneth Jackson was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.