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KENNETH DOLEN JACKSON MD
NPI 1295898179
Surgery in Kansas City, MO

Active since December 19, 2006PECOS Enrolled
930 CARONDELET DR, SUITE 104, KANSAS CITY, MO 64114(816) 941-2222(816) 941-2282 Get Directions Write a Review

NPPES record last updated: October 15, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kenneth Dolen Jackson Md NPPES

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

KENNETH DOLEN JACKSON MD (NPI 1295898179) is an individual surgery provider in Kansas City, Missouri, licensed in Missouri (2008033152) and active in the NPI registry since December 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1295898179
Entity TypeIndividualMale
Primary Taxonomy208600000X
Provider Legal NameKENNETH DOLEN JACKSONCredential: MD
Location Address930 CARONDELET DR, SUITE 104Kansas City, MO 64114-4855
Mailing Address930 Carondelet Dr 201Kansas City, MO 64114-4698 · (816) 941-2222 · Fax (816) 941-2282
Phone(816) 941-2222
Fax(816) 941-2282
Sole ProprietorNo
Enumeration DateDecember 19, 2006
Last NPPES UpdateOctober 15, 2015
✔ NPI 1295898179 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in MO · 2008033152
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedOtolaryngologyTaxonomy 207Y00000X · License 9406666 (KS)
930 CARONDELET DR, Kansas City, MO 64114
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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 (PECOS)

Kenneth Dolen Jackson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 64114 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
$85.82 typical visit price
range $55.29 – $168.52
Typical copayment $21.45 (range $13.82 – $42.13)
Most-billed visit code 99203
Established Patient
$69.10 typical visit price
range $17.60 – $137.20
Typical copayment $17.27 (range $4.40 – $34.30)
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 20

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

DR. ROBERT TIAN-RUN TUNG MD
Internal Medicine (Clinical Cardiac Electrophysiology)
930 CARONDELET DR, SUITE 200
KANSAS CITY, MO 64114
Jackson County (816) 941-7727
DR. PAUL V NIEWRZEL M.D.
Specialist
930 CARONDELET DR, SUITE 300
KANSAS CITY, MO 64114
Jackson County (816) 941-2700
PATRICIA B COOPER APRN
Nurse Practitioner
930 CARONDELET DR, STE 201
KANSAS CITY, MO 64114
Jackson County (913) 956-2250
ROBERT M GLUECK M.D.
Internal Medicine (Cardiovascular Disease)
930 CARONDELET DR, SUITE 200
KANSAS CITY, MO 64114
Jackson County (816) 941-7727
DR. ARMISA TONGSON CULLENS M.D.
Pediatrics
930 CARONDELET DR, SUITE 303
KANSAS CITY, MO 64114
Jackson County (816) 941-0440
DENNISON R HAMILTON MD PA
Orthopaedic Surgery
930 CARONDELET DR, STE. 320
KANSAS CITY, MO 64114
Jackson County (816) 943-6400
LABORATORY CORPORATION OF AMERICA HOLDINGS
Clinical Medical Laboratory
930 CARONDELET DR
KANSAS CITY, MO 64114
Jackson County (913) 338-4070
MRS. KATHRYN KELLY OCONNOR LCPC LPC
Counselor
930 CARONDELET DR, ST JOSEPH MEDICAL BLDG STE 300
KANSAS CITY, MO 64114
Jackson County (913) 642-1112

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 1295898179. It was assigned to this individual provider in the NPPES registry on December 19, 2006.

Where is Kenneth Jackson located?

Kenneth Jackson practices at 930 Carondelet Dr Suite 104, Kansas City, MO 64114. The listed phone number is (816) 941-2222.

What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Kenneth Jackson enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on October 15, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.