1. Home
  2. Directory
  3. Georgia
  4. Roswell
  5. Otolaryngology
  6. NPI Profile

DR. KEITH JACKSON MD
NPI 1225016454
Otolaryngology in Roswell, GA

Active since January 06, 2006PECOS EnrolledAccepts Medicare Assignment
1360 UPPER HEMBREE RD STE 201B, ROSWELL, GA 30076(770) 475-3361 Get Directions Write a Review

NPPES record last updated: October 15, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Keith Jackson Md NPPES

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

DR. KEITH JACKSON MD (NPI 1225016454) is an individual otolaryngology provider in Roswell, Georgia, licensed in Georgia (027575) and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS, is affiliated with Mountain Lakes Medical Center, and maintains a secondary practice location in Roswell.

NPPES Registry Identity

NPI1225016454
Entity TypeIndividualMale
Primary Taxonomy207Y00000X
Provider Legal NameDR. KEITH JACKSONCredential: MD
Location Address1360 UPPER HEMBREE RD STE 201BRoswell, GA 30076-1230
Mailing Address12080 Wildwood Springs DrRoswell, GA 30075-1887 · (770) 475-3361 · Fax (770) 664-4431
Phone(770) 475-3361
Sole ProprietorNo
Medical School CMSMedical College Of Georgia School Of MedicineGraduated 1983
Enumeration DateJanuary 6, 2006
Last NPPES UpdateOctober 15, 2019
✔ NPI 1225016454 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
License✔ Licensed in GA · 027575
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
1360 UPPER HEMBREE RD STE 201B, Roswell, GA 30076
Open in Google Maps ↗

Secondary Practice Location 1

Location 111685 Alpharetta Hwy, Suite 300Roswell, GA 30076-4913 · Phone (770) 475-3361 · Fax (770) 664-4431

Other Identifiers 2

Medicaid00377539BGA
Medicaid00377539CGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health and more.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. Keith Jackson Md 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 ID4183685530
PECOS Enrollment IDI20041020000342
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.

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 30076 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.

Referred Medical Equipment & Supplies CMS DME claims 7

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
3 suppliers14 claims14 services$33.52 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
3 suppliers11 claims11 services$66.79 avg. paid by Medicare
Cushion for use on nasal mask interface, replacement only, each A7032
DME-Other DME · category DE001N
4 suppliers13 claims78 services$14.53 avg. paid by Medicare
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034
DME-Other DME · category DE001N
5 suppliers19 claims19 services$45.86 avg. paid by Medicare
Headgear used with positive airway pressure device A7035
DME-Other DME · category DE001N
4 suppliers13 claims13 services$12.20 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
4 suppliers23 claims138 services$1.45 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 5

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

VISHAL NARWANI TARACHANDANI MD
Otolaryngology
1360 UPPER HEMBREE RD STE 201B
ROSWELL, GA 30076
Fulton County (770) 475-3361
MICHAEL CANFAROTTA MD
Otolaryngology (Otology & Neurotology)
1360 UPPER HEMBREE RD STE 201B
ROSWELL, GA 30076
Fulton County (770) 475-3361
FIYIN SOKOYA MD
Otolaryngology (Plastic Surgery within the Head & Neck)
1360 UPPER HEMBREE RD STE 201B
ROSWELL, GA 30076
Fulton County (770) 475-3361
KIA RENEE JONES MD
Otolaryngology
1360 UPPER HEMBREE RD STE 201B
ROSWELL, GA 30076
Fulton County (770) 475-3361
TIFFANIE LEIGH-ANNE EVANS
Physician Assistant
1360 UPPER HEMBREE RD STE 201B
ROSWELL, GA 30076
Fulton County (770) 475-3361

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 1225016454. It was assigned to this individual provider in the NPPES registry on January 6, 2006.

Where is Keith Jackson located?

Keith Jackson practices at 1360 Upper Hembree Rd Ste 201B, Roswell, GA 30076. The listed phone number is (770) 475-3361.

What is Keith Jackson's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Is Keith Jackson enrolled in Medicare?

Yes. Keith 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 Keith Jackson accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Keith 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 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 October 15, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.