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KENNETH WILLIAM JACKSON PA
NPI 1194587824
Physician Assistant in Idaho Falls, ID

Active since January 29, 2024PECOS EnrolledAccepts Medicare Assignment
3200 CHANNING WAY STE A206, IDAHO FALLS, ID 83404(208) 529-2230(208) 561-8061 Get Directions Write a Review

NPPES record last updated: June 9, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kenneth William Jackson Pa NPPES

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

KENNETH WILLIAM JACKSON PA (NPI 1194587824) is an individual physician assistant in Idaho Falls, Idaho, licensed in Idaho (7871497) and active in the NPI registry since January 2024. He is enrolled in Medicare PECOS, is affiliated with Baptist Health Corbin, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1194587824
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameKENNETH WILLIAM JACKSONCredential: PA
Location Address3200 CHANNING WAY STE A206Idaho Falls, ID 83404-7586
Mailing Address3200 Channing Way Ste A206Idaho Falls, ID 83404-7586 · (208) 529-2230 · Fax (208) 561-8061
Phone(208) 529-2230
Fax(208) 561-8061
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateJanuary 29, 2024
Last NPPES UpdateJune 9, 2026
NPPES CertifiedJune 9, 2026
✔ NPI 1194587824 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Licenses✔ Licensed in ID · 7871497✔ Licensed in KY · TC075
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
3200 CHANNING WAY STE A206, Idaho Falls, ID 83404
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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

Kenneth William Jackson Pa 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 ID4789118795
PECOS Enrollment IDI20241113004011, I20260420000880
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.

Hospital Affiliations CMS Care Compare

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

Baptist Health Corbin

Acute Care Hospitals · Corbin, KY
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number180080
LocationOne Trillium WayCorbin, KY 40701 · Whitley County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83404 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
$81.13 typical visit price
range $52.44 – $160.17
Typical copayment $20.28 (range $13.11 – $40.04)
Most-billed visit code 99203
Established Patient
$65.77 typical visit price
range $16.68 – $130.93
Typical copayment $16.44 (range $4.17 – $32.73)
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 6

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

ASHLEY MORGAN KLINK PA-C
Physician Assistant
3200 CHANNING WAY STE A206
IDAHO FALLS, ID 83404
Bonneville County (208) 529-2230
STEELE LAKE SPECIALTY PLLC
Surgery
3200 CHANNING WAY STE A206
IDAHO FALLS, ID 83404
Bonneville County (208) 529-2230
MRS. MCKENZIE HART
Physician Assistant
3200 CHANNING WAY STE A206
IDAHO FALLS, ID 83404
Bonneville County (208) 529-2230
CHANCE SMITH
Surgery
3200 CHANNING WAY STE A206
IDAHO FALLS, ID 83404
Bonneville County (208) 529-2230
DERRICK RAY JORGENSEN
Physician Assistant
3200 CHANNING WAY STE A206
IDAHO FALLS, ID 83404
Bonneville County (208) 529-2230
DANIEL B RICK PA
Physician Assistant
3200 CHANNING WAY STE A206
IDAHO FALLS, ID 83404
Bonneville County (208) 529-2230

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 1194587824. It was assigned to this individual provider in the NPPES registry on January 29, 2024.

Where is Kenneth Jackson located?

Kenneth Jackson practices at 3200 Channing Way Ste A206, Idaho Falls, ID 83404. The listed phone number is (208) 529-2230.

What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

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.

Is Kenneth Jackson affiliated with any hospitals?

According to CMS data, Kenneth Jackson is affiliated with Baptist Health Corbin.

When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on June 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.