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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JACKSON MARK BENNETT
NPI 1366070328
Radiology - Diagnostic Radiology in Roseville, MN

Active since March 27, 2020PECOS EnrolledAccepts Medicare Assignment
2355 HWY 36 W, STE 100, ROSEVILLE, MN 55113(651) 292-2000 Get Directions Write a Review

NPPES record last updated: July 7, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 7, 2026, Jun 30, 2025, Mar 27, 2020 (3 updates tracked since 2020).

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

NPI1366070328
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameJACKSON MARK BENNETT
Location Address2355 HWY 36 W, STE 100Roseville, MN 55113
Mailing Address2355 Hwy 36 W, Ste 100Roseville, MN 55113 · (651) 292-2000
Phone(651) 292-2000
Sole ProprietorNo
Medical School CMSBaylor College Of MedicineGraduated 2020
Enumeration DateMarch 27, 2020
Last NPPES UpdateJuly 7, 20263 updates tracked since enumeration
NPPES CertifiedJuly 7, 2026
✔ NPI 1366070328 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Licenses✔ Licensed in WI · 77424✔ Licensed in MN · 81981✔ Licensed in ND · 24149
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
2355 HWY 36 W, Roseville, MN 55113
Open in Google Maps ↗

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

Jackson Mark Bennett 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 ID7113342148
PECOS Enrollment IDI20250514002925
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 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, WI
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520063
Location3200 Pleasant Valley RoadWest Bend, WI 53095 · Washington County
Emergency services Birthing friendly

Community Memorial Hospital

Acute Care Hospitals · Menomonee Falls, WI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520103
LocationW180 N8085 Town Hall RdMenomonee Falls, WI 53051 · Waukesha County
Emergency services

Froedtert Memorial Lutheran Hospital

Acute Care Hospitals · Milwaukee, WI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number520177
Location9200 W Wisconsin AveMilwaukee, WI 53226 · Milwaukee County
Emergency services Birthing friendly

Froedtert Community Hospital

Acute Care Hospitals · New Berlin, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number520213
Location4805 S Moorland RdNew Berlin, WI 53151 · Waukesha County
Emergency services

Physician 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.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
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. DARRIN LEE JOHNSON M.D.
Radiology (Diagnostic Radiology)
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
SAMUEL JANG MD
Radiology (Diagnostic Radiology)
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
ASHLEY HUNDLEY CNP
Nurse Practitioner (Family)
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
ZACHARY FRIEDERICHS
Physician Assistant
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
DR. GEORGE V. CHESTEEN II MD
Radiology (Diagnostic Radiology)
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
DENNIS K KOBIRI MD
Radiology (Diagnostic Radiology)
2355 HWY 36 W, STE 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
JACK CHEN MD
Radiology (Diagnostic Radiology)
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000
DR. NOLAN S SHEN DO
Radiology (Diagnostic Radiology)
2355 HWY 36 W, STE. 100
ROSEVILLE, MN 55113
Ramsey County (651) 292-2000

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 system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

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 38 days 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.