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MR. JACK LOGAN KEITH JR. PMHNP
NPI 1982968210
Nurse Practitioner - Psychiatric/Mental Health in Olympia, WA

Active since July 02, 2012PECOS Enrolled
3857 MARTIN WAY E, OLYMPIA, WA 98506(253) 581-7020 Get Directions Write a Review

NPPES record last updated: December 7, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 3, 2025, Dec 7, 2022, Oct 13, 2022 and 3 more (6 updates tracked since 2020).

About Mr. Jack Logan Keith Jr. Pmhnp NPPES

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

MR. JACK LOGAN KEITH JR. PMHNP (NPI 1982968210) is an individual psychiatric/mental health provider in Olympia, Washington, licensed in Washington (AP61193548) and active in the NPI registry since July 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1982968210
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameMR. JACK LOGAN KEITH JR.Credential: PMHNP
Location Address3857 MARTIN WAY EOlympia, WA 98506
Mailing Address3857 Martin Way EOlympia, WA 98506
Phone(253) 581-7020
Sole ProprietorNo
Enumeration DateJuly 2, 2012
Last NPPES UpdateDecember 7, 20226 updates tracked since enumeration
NPPES CertifiedDecember 7, 2022
✔ NPI 1982968210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Licenses✔ Licensed in WA · AP61193548✔ Licensed in OR · 202110580NP-PP
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedRegistered NurseTaxonomy 163W00000X · License N60493722 (WA)
3857 MARTIN WAY E, Olympia, WA 98506
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Kaiser Permanente, Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jack Logan Keith Jr. Pmhnp 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 Jack Keith reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mindful Mental Health, PLLC
17 mi
Psychiatric/Mental Health
6102 84TH AVENUE CT W
University Place, WA 98467
  • Reassigned Medicare billing, Washington enrollment
NPI 1932089281 (360) 870-5411
Mindful Therapy Group PC
58 mi
Clinical
6505 216TH ST SW STE 100
Mountlake Terrace, WA 98043
  • Reassigned Medicare billing, Oregon and Washington enrollments
  • 234 clinicians in this Medicare group
NPI 1316238678 (425) 640-7009

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98506 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
$88.29 typical visit price
range $57.27 – $172.80
Typical copayment $22.07 (range $14.31 – $43.20)
Most-billed visit code 99203
Established Patient
$100.78 typical visit price
range $18.56 – $141.11
Typical copayment $25.19 (range $4.64 – $35.27)
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.

PAMELA KAY BODINE
Counselor (Mental Health)
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
ALYSSA COMPTON CLARK
Community Health Worker
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
DANIELE BRITTNEY MAURER
Counselor (Mental Health)
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
LEAH J VAN TIEM CLINICIAN
Counselor
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
AMANDA VIOLET WELCH
Counselor
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
ALYSSA LONG
Counselor
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
GEORGE PETZINGER M.D.
Psychiatry & Neurology (Psychiatry)
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170
MS. FRANCES LYN HERTZ MA LMHC
Counselor (Mental Health)
3857 MARTIN WAY E
OLYMPIA, WA 98506
Thurston County (360) 704-7170

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 Jack Keith's NPI number?

The NPI number for Jack Keith is 1982968210. It was assigned to this individual provider in the NPPES registry on July 2, 2012.

Where is Jack Keith located?

Jack Keith practices at 3857 Martin Way E, Olympia, WA 98506. The listed phone number is (253) 581-7020.

What is Jack Keith's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Jack Keith enrolled in Medicare?

Yes. Jack Keith is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Jack Keith's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Keith reassigns Medicare benefits to 2 organizations: Mindful Mental Health, PLLC (University Place, WA) and Mindful Therapy Group PC (Mountlake Terrace, WA). 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 Jack Keith's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Keith accept?

Health plans from Kaiser Permanente and Premera Blue Cross Blue Shield of Alaska list Jack Keith 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 Jack Keith was last updated on December 7, 2022. 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.