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KENNETH C JACKSON M.D.
NPI 1457491037
Specialist in Warr Acres, OK

Active since February 06, 2007PECOS Enrolled
7301 N COMANCHE AVE, OU PHYSICIANS, WARR ACRES, OK 73132(405) 721-8090(405) 722-8529 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kenneth C Jackson M.d. NPPES

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

KENNETH C JACKSON M.D. (NPI 1457491037) is an individual specialist in Warr Acres, Oklahoma, licensed in Oklahoma (11030) and active in the NPI registry since February 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457491037
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameKENNETH C JACKSONCredential: M.D.
Location Address7301 N COMANCHE AVE, OU PHYSICIANSWarr Acres, OK 73132-6646
Mailing Address7301 N Comanche AveWarr Acres, OK 73132-6646 · (405) 721-8090 · Fax (405) 722-8529
Phone(405) 721-8090
Fax(405) 722-8529
Sole ProprietorNo
Enumeration DateFebruary 6, 2007
Last NPPES UpdateMarch 7, 2023
✔ NPI 1457491037 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in OK · 11030
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
7301 N COMANCHE AVE, Warr Acres, OK 73132
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Other Identifiers 1

Other11030OK · License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth C Jackson M.d. 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.

Medicare Billing Reassignments

2

Medicare enrollment records show Kenneth Jackson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ou Health Partners, Inc
8.1 mi
Multi-Specialty
1200 CHILDRENS AVE STE 11200
Oklahoma City, OK 73104
  • Reassigned Medicare billing, Oklahoma enrollment
  • 1,795 clinicians in this Medicare group
NPI 1528642642 (405) 271-3932
Board Of Regents Of The University Of Oklahoma - Ou Physicians
8.1 mi
Multi-Specialty
825 NE 10TH ST
Oklahoma City, OK 73104
  • Reassigned Medicare billing, Oklahoma enrollment
  • 845 clinicians in this Medicare group
NPI 1801869250 (405) 271-3932

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

Other Providers at the Same Location NPPES 12

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

GRAND PRAIRIE PEDIATRICS
Clinic/Center (Primary Care)
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 721-8090
TERRI DENISE COBB LPC-S
Counselor
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 761-8358
SARA BEATRIZ CAYALO SERRUDO
Counselor (Mental Health)
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 761-8358
KATHERINE GALGANI RENSING CPNP-PC
Nurse Practitioner (Pediatrics)
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 271-4646
ELIZABETH ANNE HARRIS PA C
Physician Assistant
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 271-4646
DR. MARY ELLEN STOCKETT M.D.
Pediatrics
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 721-8090
L4 CLINICAL MANAGEMENT LLC
Family Medicine
7301 N COMANCHE AVE
WARR ACRES, OK 73132
Oklahoma County (405) 728-2100
CARY ARDIS FISHER MD
Family Medicine
7301 N COMANCHE AVE, SUITE B
WARR ACRES, OK 73132
Oklahoma County (405) 728-2100

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 1457491037. It was assigned to this individual provider in the NPPES registry on February 6, 2007.

Where is Kenneth Jackson located?

Kenneth Jackson practices at 7301 N Comanche Ave Ou Physicians, Warr Acres, OK 73132. The listed phone number is (405) 721-8090.

What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Kenneth Jackson enrolled in Medicare?

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

Which organizations bill Medicare for Kenneth Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Jackson reassigns Medicare benefits to 2 organizations: Ou Health Partners, Inc (Oklahoma City, OK) and Board Of Regents Of The University Of Oklahoma - Ou Physicians (Oklahoma City, OK). 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 Kenneth Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on March 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.