DR. KENNETH JAKE SAMPLE MD
NPI 1699358960
Internal Medicine in Gravette, AR

Active since May 04, 2021PECOS EnrolledAccepts Medicare Assignment
1101 JACKSON ST SW, GRAVETTE, AR 72736(479) 787-5221(479) 787-5613 Get Directions Write a Review

NPPES record last updated: August 5, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 5, 2024, Jun 26, 2024, May 14, 2021 and 1 more (4 updates tracked since 2021).

About Dr. Kenneth Jake Sample Md NPPES

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

DR. KENNETH JAKE SAMPLE MD (NPI 1699358960) is an individual internal medicine provider in Gravette, Arkansas, licensed in Arkansas (E-18299) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1699358960
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. KENNETH JAKE SAMPLECredential: MD
Location Address1101 JACKSON ST SWGravette, AR 72736-9121
Mailing Address1101 Jackson St SwGravette, AR 72736-9121
Fax(479) 787-5613
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateMay 4, 2021
Last NPPES UpdateAugust 5, 20244 updates tracked since enumeration
NPPES CertifiedAugust 5, 2024
NPI 1699358960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License Licensed in AR · E-18299
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

1101 JACKSON ST SW, Gravette, AR 72736

Secondary Practice Locations 2

Location 1920 Madison Ave Ste 447Memphis, TN 38103-3438 · Phone (901) 448-5814
Location 2346 N Main StDecatur, AR 72722-9732 · Phone (479) 752-3233 · Fax (479) 752-3235

Accepted Insurance

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

Dr. Kenneth Jake Sample Md 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 ID244630200
PECOS Enrollment IDI20240816001640
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 72736 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
$119.36 typical visit price
range $51.36 – $157.74
Typical copayment $29.84 (range $12.84 – $39.43)
Most-billed visit code 99204
Established Patient
$91.63 typical visit price
range $16.16 – $128.77
Typical copayment $22.90 (range $4.04 – $32.19)
Most-billed visit code 99214
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.

Family Medicine
1101 JACKSON ST SW
GRAVETTE, AR 72736
Nurse Practitioner
1101 JACKSON ST SW
GRAVETTE, AR 72736
Nurse Practitioner (Psychiatric/Mental Health)
1101 JACKSON ST SW
GRAVETTE, AR 72736
Nurse Practitioner (Psychiatric/Mental Health)
1101 JACKSON ST SW
GRAVETTE, AR 72736
Emergency Medicine
1101 JACKSON ST SW
GRAVETTE, AR 72736
Clinical Nurse Specialist
1101 JACKSON ST SW
GRAVETTE, AR 72736
Podiatrist (Foot & Ankle Surgery)
1101 JACKSON ST SW
GRAVETTE, AR 72736
General Acute Care Hospital (Critical Access)
1101 JACKSON ST SW
GRAVETTE, AR 72736

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 Sample's NPI number?

The NPI number for Kenneth Sample is 1699358960. It was assigned to this individual provider in the NPPES registry on May 4, 2021.

Where is Kenneth Sample located?

Kenneth Sample practices at 1101 Jackson St SW, Gravette, AR 72736. The listed phone number is (479) 787-5221.

What is Kenneth Sample's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Kenneth Sample enrolled in Medicare?

Yes. Kenneth Sample 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.

What insurance does Kenneth Sample accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health and Ambetter from Sunflower Health Plan and 2 other insurers list Kenneth Sample 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.

When was this NPI record last updated?

The NPPES record for Kenneth Sample was last updated on August 5, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.