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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

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

Active since June 30, 2005PECOS Enrolled
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: August 09, 2026.

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

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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
Quality87.73
Promoting Interoperability82
Improvement Activities40
Cost71.28

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.

What insurance does Kenneth Jackson accept?

Health plans from Blue Cross Blue Shield of Arizona and UnitedHealthcare list Kenneth Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

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 33 days 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.