DR. KEITH RYAN JACKSON M.D.
NPI 1124116041
Dermatology in Staten Island, NY

Q: What is Keith Jackson's NPI number?

The NPI number for Keith Jackson is 1124116041. It was assigned to this individual provider in the NPPES registry on October 10, 2006.

Q: What is Keith Jackson's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Q: When was this NPI record last updated?

The NPPES record for Keith Jackson was last updated on May 28, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.

Active since October 10, 2006PECOS Enrolled

100/100

CMS Quality Rating

11 RALPH PL, SUITE 209, STATEN ISLAND, NY 10304(718) 727-1331(718) 727-2159 Get Directions Write a Review

NPPES record last updated: May 28, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Keith Ryan Jackson M.d. NPPES

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

DR. KEITH RYAN JACKSON M.D. (NPI 1124116041) is an individual dermatology provider in Staten Island, New York, licensed in New York (212165) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS, is affiliated with Mountain Lakes Medical Center, and is a graduate of State University Of New York Downstate Medical Center (1997).

NPPES Registry Identity

NPI1124116041

Entity TypeIndividualMale

Primary Taxonomy207N00000X

Provider Legal NameDR. KEITH RYAN JACKSONCredential: M.D.

Location Address11 RALPH PL, SUITE 209Staten Island, NY 10304-4419

Mailing Address11 Ralph Pl, Suite 209Staten Island, NY 10304-4419 · (718) 727-1331 · Fax (718) 727-2159

Phone(718) 727-1331

Fax(718) 727-2159

Sole ProprietorYes

Medical School CMSState University Of New York Downstate Medical CenterGraduated 1997

Enumeration DateOctober 10, 2006

Last NPPES UpdateMay 28, 2013

✔ NPI 1124116041 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians

Taxonomy Code207N00000X

License✔ Licensed in NY · 212165

Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

11 RALPH PL, Staten Island, NY 10304

Open in Google Maps ↗

Other Identifiers 3

Medicare ID-Type UnspecifiedW31031NY

Medicare UPINH13115NY

Medicaid02239307NY

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Keith Ryan Jackson M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3779536057

PECOS Enrollment IDI20050228000013

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 18

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.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

1,487 services673 patients

Destruction of precancer skin growth, 2-14 growths 17003

This procedure involves removing 2-14 precancerous skin growths. The growths are treated to prevent them from potentially developing into skin cancer. The process is safe, with minimal discomfort, and promotes healthier skin.

1,145 services228 patients

Destruction of skin growth, 1-14 growths 17110

"Destruction of skin growth" refers to a procedure where 1-14 abnormal skin growths are removed. This is done using methods such as freezing, burning, or laser therapy. It helps prevent the growth from causing discomfort or turning into a more serious condition.

807 services472 patients

Destruction of precancer skin growth, 1 growth 17000

"Destruction of precancer skin growth" is a procedure that eliminates a single precancerous skin growth. This is done to prevent it from developing into skin cancer. The growth may be removed using various methods such as cryotherapy (freezing), laser therapy, or topical medications.

635 services424 patients

Destruction of precancer skin growth, 15 or more growths 17004

This procedure involves removing 15 or more precancerous skin growths to prevent them from developing into cancer. It's done using various methods like freezing, creams, or minor surgery. The goal is to protect your health by stopping cancer before it starts.

274 services143 patients

Biopsy of related skin growth, first growth 11102

A biopsy of a skin growth involves taking a small sample of the growth to examine it under a microscope. This helps determine if the growth is harmful. The procedure is typically quick, with minimal discomfort. It's a crucial step in ensuring your skin's health.

273 services235 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

242 services241 patients

Destruction of skin growth, 15 or more growths 17111

"Destruction of skin growth" refers to a procedure where unwanted skin growths, such as warts or moles, are removed. In this case, 15 or more growths are treated. Techniques may include freezing, burning, or laser therapy. It's a safe, quick process to improve skin health.

166 services118 patients

Acne surgery 10040

Acne surgery is a procedure to clear up severe acne that doesn't respond to other treatments. It involves a dermatologist using specialized tools to remove blackheads, whiteheads, and pimples. This helps to reduce the appearance of acne and prevent future breakouts.

150 services121 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

134 services24 patients

Biopsy of related skin growth, each additional growth 11103

A biopsy of related skin growth is a procedure where a small piece of skin growth is removed for testing. If additional growths are identified, they may also be biopsied. This helps in diagnosing skin conditions and planning appropriate treatment.

68 services58 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

62 services43 patients

Simple or single drainage of skin abscess 10060

A simple or single drainage of skin abscess is a procedure to remove pus from a skin infection. A small cut is made on the abscess, the pus is drained out, and the area is cleaned. This helps to reduce pain, speed up recovery, and prevent the spread of infection.

45 services35 patients

Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm 17263

This procedure targets and eliminates a cancerous skin growth between 2.1 and 3.0 cm on your trunk, arms, or legs. It's done by applying specific treatments like heat, cold, or medicated creams to destroy the cancer cells, preventing them from spreading.

35 services29 patients

Injection into skin growth, 1-7 growths 11900

This procedure involves injecting medication into 1-7 skin growths. The medication helps to reduce the size of the growths or completely eliminate them. It's a simple, quick, and usually painless process performed by a medical professional.

28 services18 patients

Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 2.1-3.0 cm 17283

This procedure involves the removal of a cancerous skin growth on the face, ears, eyelids, nose, lips, or mouth. The growth is between 2.1-3.0 cm in size. The goal is to eliminate the cancer and reduce the risk of it spreading.

18 services17 patients

Biopsy of eyelid 67810

A biopsy of the eyelid is a procedure where a small piece of tissue is taken from your eyelid for examination. It helps identify any abnormal growth like a lump or cyst. It's done under local anesthesia, so you won't feel pain during the process.

12 services11 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.

12 services12 patients

Hospital Affiliations CMS Care Compare

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

Mountain Lakes Medical Center

Critical Access Hospitals · Clayton, GA

OwnershipProprietary

CMS Certification Number111336

Location162 Legacy PointClayton, GA 30525 · Rabun County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10304 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$83.44 typical visit price

range $21.66 – $164.45

Typical copayment $20.86 (range $5.41 – $41.11)

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.

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.

100/100

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

Individually scored

Quality

100

Promoting Interoperability

100

Improvement Activities

Reported Quality Measures

Advance Care Plan

100%1,395 patients5/55-star benchmark: 100%

Documentation of Current Medications in the Medical Record

100%4,702 patients5/55-star benchmark: 100%

Melanoma: Continuity of Care - Recall System

100%89 patients

Patient-Centered Surgical Risk Assessment and Communication

100%45 patients5/55-star benchmark: 100%

Provide Patients Electronic Access to Their Health Information

91%2,781 patients4/55-star benchmark: 100%

Tobacco Use and Help with Quitting Among Adolescents

100%167 patients5/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

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.

DR. NADUBEETHI JAYARAM MD

Orthopaedic Surgery

11 RALPH PL, SUITE 102 RICHMOND ORTHOPAEDICS
STATEN ISLAND, NY 10304

Richmond County (718) 447-6545

DR. CORALIA TONE D.D.S.

Dentist (General Practice)

11 RALPH PL, SUITE 205
STATEN ISLAND, NY 10304

Richmond County (718) 447-4113

EMPIRE VISION CARE LLC

Optometrist

11 RALPH PL
STATEN ISLAND, NY 10304

Richmond County (732) 443-7638

GEORGE J RETTAGLIATA MD

Internal Medicine

11 RALPH PL, STE 308
STATEN ISLAND, NY 10304

Richmond County (718) 442-2882

SUO-MAW CHOU MD

Internal Medicine

11 RALPH PL
STATEN ISLAND, NY 10304

Richmond County (718) 567-1006

MR. CHINAGANDHAM SRINIVISA BHUPATHI

Orthopaedic Surgery

11 RALPH PL, SUITE 102
STATEN ISLAND, NY 10304

Richmond County (718) 447-6545

FANNY B KASHER MD LLC

Surgery

11 RALPH PL, SUITE 102
STATEN ISLAND, NY 10304

Richmond County (718) 273-5974

VLADIMIR RUBINSHTEYN MD

Surgery (Trauma Surgery)

11 RALPH PL
STATEN ISLAND, NY 10304

Richmond County (718) 273-5666

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 Keith Jackson's NPI number?

The NPI number for Keith Jackson is 1124116041. It was assigned to this individual provider in the NPPES registry on October 10, 2006.

Where is Keith Jackson located?

Keith Jackson practices at 11 Ralph Pl Suite 209, Staten Island, NY 10304. The listed phone number is (718) 727-1331.

What is Keith Jackson's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Keith Jackson enrolled in Medicare?

Yes. Keith Jackson is registered in the Medicare PECOS enrollment system.

Is Keith Jackson affiliated with any hospitals?

According to CMS data, Keith Jackson is affiliated with Mountain Lakes Medical Center.

When was this NPI record last updated?

The NPPES record for Keith Jackson was last updated on May 28, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.