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KEVIN JACKSON DO
NPI 1104381573
Ophthalmology in Atlanta, GA

Active since February 09, 2019PECOS EnrolledAccepts Medicare Assignment
800 MOUNT VERNON HWY NE STE 130, ATLANTA, GA 30328(404) 256-1125 Get Directions Write a Review

NPPES record last updated: September 20, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kevin Jackson Do NPPES

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

KEVIN JACKSON DO (NPI 1104381573) is an individual ophthalmology provider in Atlanta, Georgia, licensed in Georgia (95793) and active in the NPI registry since February 2019. He is enrolled in Medicare PECOS, is affiliated with Clinch Valley Medical Center, and maintains a secondary practice location in Far Rockaway.

NPPES Registry Identity

NPI1104381573
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameKEVIN JACKSONCredential: DO
Location Address800 MOUNT VERNON HWY NE STE 130Atlanta, GA 30328-4293
Mailing Address906 Wedgewood TerWestminster, MD 21158-3654
Phone(404) 256-1125
Sole ProprietorYes
Medical School CMSLiberty Univ College Of Osteopathic MedicineGraduated 2019
Enumeration DateFebruary 9, 2019
Last NPPES UpdateSeptember 20, 2023
NPPES CertifiedSeptember 20, 2023
✔ NPI 1104381573 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
License✔ Licensed in GA · 95793
Definition
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
800 MOUNT VERNON HWY NE STE 130, Atlanta, GA 30328
Open in Google Maps ↗

Secondary Practice Location 1

Location 1327 Beach 19th StFar Rockaway, NY 11691-4423 · Phone (718) 869-7000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., BlueCross BlueShield of Tennessee.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

Kevin Jackson Do 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 ID4082077425
PECOS Enrollment IDI20230831003462, I20231003001700, I20240520003972
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.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of cataract with insertion of prosthetic lens 66984
This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
53 services32 patients
Measurement of corneal curvature and depth of eye 92136
This procedure measures the shape and depth of your eye, specifically the cornea, the clear front surface. It helps in diagnosing conditions, planning for surgeries, or fitting contact lenses. It's non-invasive and painless.
45 services44 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
26 services24 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
21 services21 patients
New patient complete exam of visual system 92004
A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
20 services20 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Clinch Valley Medical Center

Acute Care Hospitals · Richlands, VA
3/5 CMS rating
OwnershipProprietary
CMS Certification Number490060
Location6801 Governor Gc Perry HighwayRichlands, VA 24641 · Tazewell County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30328 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
$130.64 typical visit price
range $56.84 – $172.43
Typical copayment $32.66 (range $14.21 – $43.10)
Most-billed visit code 99204
Established Patient
$70.85 typical visit price
range $18.22 – $140.40
Typical copayment $17.71 (range $4.55 – $35.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

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

DR. ELTON ANGONI OD, MS
Optometrist
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (404) 256-1125
KRISHMA ZAVER OD
Optometrist
800 MOUNT VERNON HWY NE STE 130
SANDY SPRINGS, GA 30328
Fulton County (678) 431-4411
SAHHIR MERCHANT OD
Optometrist
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (404) 237-1770
MAITHILI PATEL OD
Optometrist
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (404) 256-1125
DR. SOJEONG LEE OD
Student in an Organized Health Care Education/Training Program
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (404) 256-1125
SAMEERAH ALKHAIRY ALI MD
Ophthalmology
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (404) 256-1125
BRENDA LUU OD
Optometrist
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (770) 255-1249
DR. CHANG YE OD, PH.D
Optometrist
800 MOUNT VERNON HWY NE STE 130
ATLANTA, GA 30328
Fulton County (770) 255-1249

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 Kevin Jackson's NPI number?

The NPI number for Kevin Jackson is 1104381573. It was assigned to this individual provider in the NPPES registry on February 9, 2019.

Where is Kevin Jackson located?

Kevin Jackson practices at 800 Mount Vernon Hwy NE Ste 130, Atlanta, GA 30328. The listed phone number is (404) 256-1125.

What is Kevin Jackson's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

Is Kevin Jackson enrolled in Medicare?

Yes. Kevin 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 Kevin Jackson accept?

Health plans from Alliant Health Plans, Inc. and BlueCross BlueShield of Tennessee list Kevin 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.

Is Kevin Jackson affiliated with any hospitals?

According to CMS data, Kevin Jackson is affiliated with Clinch Valley Medical Center.

When was this NPI record last updated?

The NPPES record for Kevin Jackson was last updated on September 20, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.