KEITH RYAN JACKSON MD PC
NPI 1326216847
Dermatology in Staten Island, NY

Active since February 19, 2008
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 29, 2013. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Keith Ryan Jackson Md Pc NPPES

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

KEITH RYAN JACKSON MD PC (NPI 1326216847) is a healthcare organization registered as a dermatology in Staten Island, New York and active in the NPI registry since February 2008. The organization lists Keith Ryan Jackson, President, as its authorized official.

NPPES Registry Identity

NPI1326216847
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameKEITH RYAN JACKSON MD PC
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
Fax(718) 727-2159
Organization SubpartNo
Authorized OfficialKeith Ryan JacksonPresident · (718) 727-1331
Enumeration DateFebruary 19, 2008
Last NPPES UpdateMay 29, 2013
✔ NPI 1326216847 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

Other Identifiers 3

Medicare PINW31031NY
Medicare UPINH13115NY
Medicaid02239307NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keith Ryan Jackson Md Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Keith Ryan Jackson MD PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1124116041
11 RALPH PL SUITE 209
Staten Island, NY 10304
(718) 727-1331
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Ryan Jackson MD PC's NPI number?

The NPI number for Keith Ryan Jackson MD PC is 1326216847. It was assigned to this organization in the NPPES registry on February 19, 2008.

Where is Keith Ryan Jackson MD PC located?

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

What is Keith Ryan Jackson MD PC's specialty?

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

Is Keith Ryan Jackson MD PC enrolled in Medicare?

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

How many clinicians bill Medicare through Keith Ryan Jackson MD PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Keith Ryan Jackson MD PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Keith Ryan Jackson MD PC was last updated on May 29, 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.