JACKSON MARK BENNETT
NPI 1366070328
Radiology - Diagnostic Radiology in Roseville, MN
About Jackson Mark Bennett NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKSON MARK BENNETT (NPI 1366070328) is an individual diagnostic radiology provider in Roseville, Minnesota, licensed in Wisconsin (77424) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS, is affiliated with St Josephs Community Hospital West Bend, and is a graduate of Baylor College Of Medicine (2020).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jackson Mark Bennett is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
15Medicare enrollment records show Jackson Bennett reassigns Medicare billing to 15 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Roseville, MN 55113
- Reassigned Medicare billing, Minnesota enrollment
- 219 clinicians in this Medicare group
Roseville, MN 55113
- Reassigned Medicare billing, Minnesota and Wisconsin enrollments
- 218 clinicians in this Medicare group
St Paul, MN 55108
- Reassigned Medicare billing, Minnesota and Wisconsin enrollments
- Also billed through NPI 1023314804 (Minnesota), NPI 1205069325 (Wisconsin), NPI 1407395247 (Wisconsin)
- 2,609 clinicians in this Medicare group
Minneapolis, MN 55454
- Reassigned Medicare billing, Minnesota enrollment
- 2,373 clinicians in this Medicare group
Saint Paul, MN 55102
- Reassigned Medicare billing, Minnesota enrollment
- 218 clinicians in this Medicare group
Chanhassen, MN 55317
- Reassigned Medicare billing, Minnesota enrollment
- 581 clinicians in this Medicare group
Madison, MN 56256
- Reassigned Medicare billing, Minnesota enrollment
- 185 clinicians in this Medicare group
Madison, MN 56256
- Reassigned Medicare billing, Minnesota enrollment
- 177 clinicians in this Medicare group
Marshfield, WI 54449
- Reassigned Medicare billing, Minnesota enrollment
- 143 clinicians in this Medicare group
Grand Rapids, MN 55744
- Reassigned Medicare billing, Minnesota enrollment
- 555 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare 4
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
St Josephs Community Hospital West Bend
Acute Care Hospitals · West Bend, WICommunity Memorial Hospital
Acute Care Hospitals · Menomonee Falls, WIFroedtert Memorial Lutheran Hospital
Acute Care Hospitals · Milwaukee, WIFroedtert Community Hospital
Acute Care Hospitals · New Berlin, WIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55113 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
ROSEVILLE, MN 55113
ROSEVILLE, MN 55113
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 Jackson Bennett's NPI number?
The NPI number for Jackson Bennett is 1366070328. It was assigned to this individual provider in the NPPES registry on March 27, 2020.
Where is Jackson Bennett located?
Jackson Bennett practices at 2355 Hwy 36 W Ste 100, Roseville, MN 55113. The listed phone number is (651) 292-2000.
What is Jackson Bennett's specialty?
The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.
Is Jackson Bennett enrolled in Medicare?
Yes. Jackson Bennett is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Jackson Bennett's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jackson Bennett reassigns Medicare benefits to 15 organizations: Suburban Imaging, LLC (Roseville, MN), Midwest Radiology, PA (Roseville, MN), Allina Health System (St Paul, MN), Fairview Specialty Services (Minneapolis, MN), Midwest Radiology Outpatient Imaging, LLC (Saint Paul, MN) and 10 more organizations, listed in the Medicare section above. Each 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 Jackson Bennett's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jackson Bennett accept?
Health plans from Blue Cross Blue Shield of North Dakota and Sanford Health Plan list Jackson Bennett 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 Jackson Bennett affiliated with any hospitals?
According to CMS data, Jackson Bennett is affiliated with St Josephs Community Hospital West Bend, Community Memorial Hospital, Froedtert Memorial Lutheran Hospital and Froedtert Community Hospital.
When was this NPI record last updated?
The NPPES record for Jackson Bennett was last updated on July 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Jackson Mark Bennett · NPI 1366070328
Diagnostic Radiology physician in Roseville, Minnesota. Individual provider, active in the CMS NPPES registry since March 27, 2020.
## Identity
- **NPI:** 1366070328 (Entity type: Individual)
- **Enumerated:** March 27, 2020
- **Primary specialty:** Radiology - Diagnostic Radiology · taxonomy 2085R0202X
- **State license:** 77424 (Wisconsin)
- **Sole proprietor:** No
## Practice location
- **Address:** 2355 HWY 36 W, STE 100, Roseville, MN 55113
- **Phone:** (651) 292-2000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 15 organizations under Medicare reassignment (form CMS-855R): Suburban Imaging, LLC (NPI 1427008937, Roseville, MN); Midwest Radiology, PA (NPI 1952307175, Roseville, MN); Allina Health System (NPI 1265278097, St Paul, MN); Fairview Specialty Services (NPI 1043199334, Minneapolis, MN); Midwest Radiology Outpatient Imaging, LLC (NPI 1720059264, Saint Paul, MN); and 10 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Baylor College Of Medicine, class of 2020
## Record status
- **NPPES last updated:** July 7, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1366070328) · Data from the CMS NPPES public registry.