DR. KEITH DANIEL JACKSON DMD
NPI 1871935569
Dentist - Oral and Maxillofacial Surgery in Charlottesville, VA

Q: What is Keith Jackson's NPI number?

The NPI number for Keith Jackson is 1871935569. It was assigned to this individual provider in the NPPES registry on July 23, 2013.

Q: What is Keith Jackson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: Is Keith Jackson enrolled in Medicare?

No. Keith Jackson has opted out of Medicare through April 19, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Keith Jackson was last updated on March 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since July 23, 2013Opted out of Medicare · through Apr 19, 2027

244 HYDRAULIC RIDGE RD, CHARLOTTESVILLE, VA 22901(434) 973-3348(434) 977-5790 Get Directions Write a Review

NPPES record last updated: March 26, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 21, 2020, Nov 9, 2020 (2 updates tracked since 2020).

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About Dr. Keith Daniel Jackson Dmd NPPES

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

DR. KEITH DANIEL JACKSON DMD (NPI 1871935569) is an individual oral and maxillofacial surgery provider in Charlottesville, Virginia, licensed in Virginia (0401415969) and active in the NPI registry since July 2013. He has opted out of Medicare through April 19, 2027 and maintains a secondary practice location in Culpeper.

NPPES Registry Identity

NPI1871935569

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameDR. KEITH DANIEL JACKSONCredential: DMD

Location Address244 HYDRAULIC RIDGE RDCharlottesville, VA 22901-8124

Mailing Address244 Hydraulic Ridge RdCharlottesville, VA 22901-8124 · (434) 973-3348 · Fax (434) 977-5790

Phone(434) 973-3348

Fax(434) 977-5790

Sole ProprietorNo

Enumeration DateJuly 23, 2013

Last NPPES UpdateMarch 26, 20242 updates tracked since enumeration

NPPES CertifiedMay 18, 2021

✔ NPI 1871935569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in VA · 0401415969

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

244 HYDRAULIC RIDGE RD, Charlottesville, VA 22901

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Secondary Practice Location 1

Location 11400 Sunset LnCulpeper, VA 22701-3300 · Phone (540) 825-3069 · Fax (540) 825-7429

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Keith Daniel Jackson Dmd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 19, 2021 through April 19, 2027.

Opt-Out Effective DateApril 19, 2021

Opt-Out In Effect ThroughApril 19, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22901 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

$86.88 typical visit price

range $56.19 – $170.30

Typical copayment $21.72 (range $14.04 – $42.57)

Most-billed visit code 99203

Established Patient

$70.08 typical visit price

range $18.07 – $138.91

Typical copayment $17.52 (range $4.51 – $34.72)

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 9

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

SARAH ELIZABETH SNOW SUMMERS DMD, MD

Oral & Maxillofacial Surgery