Dr Kenneth Douglas Jackson, MD - Medicare Obstetrics/gynecology in Kingman, AZ

Dr Kenneth Douglas Jackson, MD is a medicare enrolled "Family Medicine" physician in Kingman, Arizona. He went to Baylor College Of Medicine and graduated in 1974 and has 50 years of diverse experience with area of expertise as Obstetrics/gynecology. He is a member of the group practice Kingman Healthcare Inc and his current practice location is 1739 E Beverly Ave, Suite 201, Kingman, Arizona. You can reach out to his office (for appointments etc.) via phone at (928) 692-3456.

Dr Kenneth Douglas Jackson is licensed to practice in Arizona (license number 12522) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1073510491.

Contact Information

Dr Kenneth Douglas Jackson, MD
1739 E Beverly Ave, Suite 201,
Kingman, AZ 86401-3593
(928) 692-3456
(928) 692-7071



Physician's Profile

Full NameDr Kenneth Douglas Jackson
GenderMale
SpecialityObstetrics/gynecology
Experience50 Years
Location1739 E Beverly Ave, Kingman, Arizona
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dr Kenneth Douglas Jackson attended and graduated from Baylor College Of Medicine in 1974
  NPI Data:
  • NPI Number: 1073510491
  • Provider Enumeration Date: 06/30/2005
  • Last Update Date: 03/07/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 9133146343
  • Enrollment ID: I20051027000503

Medical Identifiers

Medical identifiers for Dr Kenneth Douglas Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1073510491NPI-NPPES
209991MedicaidAZ
12522OtherAZLICENSE

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 12522 (Arizona)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Kingman Regional Medical CenterKingman, AZHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Kingman Healthcare Inc6901791367181

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Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kenneth Douglas Jackson allows following entities to bill medicare on his behalf.
Entity NameKingman Healthcare Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1265423917
PECOS PAC ID: 6901791367
Enrollment ID: O20040216001173

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kenneth Douglas Jackson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Kenneth Douglas Jackson, MD
1739 E Beverly Ave, Suite 201,
Kingman, AZ 86401-3593

Ph: (928) 692-3456
Dr Kenneth Douglas Jackson, MD
1739 E Beverly Ave, Suite 201,
Kingman, AZ 86401-3593

Ph: (928) 692-3456

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Family Medicine Doctors in Kingman, AZ

Ashley Marie Eyer,
Family Medicine
Medicare: Medicare Enrolled
Practice Location: 2668 Hualapai Mountain Rd, Kingman, AZ 86401
Phone: 928-718-7300    
Ted Edward Zegarra, M.D.
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 1739 E Beverly Ave, Suite 201, Kingman, AZ 86409
Phone: 928-692-3456    Fax: 928-692-7071
Matthew Bell,
Family Medicine
Medicare: Not Enrolled in Medicare
Practice Location: 3269 N Stockton Hill Rd, Kingman, AZ 86409
Phone: 928-681-8701    
Karleen Carol Adams, D.O.
Family Medicine
Medicare: Accepting Medicare Assignments
Practice Location: 3269 N Stockton Hill Rd, Kingman, AZ 86409
Phone: 928-263-4722    Fax: 928-263-4794
Tadesse Kebede Debele, MD, MS
Family Medicine
Medicare: Not Enrolled in Medicare
Practice Location: 2202 N Stockton Hill Rd Ste 101, Kingman, AZ 86401
Phone: 702-877-5199    Fax: 702-431-0265
Kirsten Mortenson, DO
Family Medicine
Medicare: Medicare Enrolled
Practice Location: 3636 N Stockton Hill Rd, Kingman, AZ 86409
Phone: 928-757-4398    Fax: 928-757-7224

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