NPIMap

Individual provider Active NPI

Kevin T Jackson, M.D.

  • Family Medicine Physician
  • Harrison, AR
National Provider Identifier
1144291907
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-2640 Issued in AR
Practice address
1420 Highway 62 65 N
Harrison, AR 72601-1959
Phone
(479) 741-3600
Fax
(870) 741-4482
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E-2640 AR Primary

Addresses

Primary practice location

1420 Highway 62 65 N
Harrison, AR 72601-1959

Mailing address

1420 Highway 62 65 N
Harrison, AR 72601-1959
Phone (479) 741-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060620000066 AR Practitioner - Family Practice 4183636921 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ozark Physical Therapy Inc.Group PAC ID 1052400850, 44 clinicians

Practice addresses (Care Compare)

115 Orendorff Ave
Harrison, AR 72601-4634
Phone (870) 741-6111

1420 Hwy 62 65 N
Suite 1
Harrison, AR 72601-1959
Phone (870) 741-6111

210 Rice St
Berryville, AR 72616-4388
Phone (870) 423-6789

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions80

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Baxter County Regional Hospital, Inc Family Medicine CurrentSince Nov 1, 2021 Accepting new patients
Baxter County Regional Hospital, Inc Family Medicine Current Accepting new patients
Washington Regional Medical System Family Medicine CurrentSince Sep 1, 2012 Accepting new patients
Baxter County Regional Hospital Inc Family Medicine CurrentSince Nov 1, 2021 Accepting new patients
Washington Regional Medical System Family Medicine CurrentSince Sep 1, 2012 Accepting new patients
QHG of Springdale Inc Past Accepting new patients
University of Arkansas for Medical Sciences Family Medicine Past Accepting new patients
University of Arkansas for Medical Sciences Family Medicine Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
Washington Regional Medical System Past Accepting new patients

Locations

1125 N College Ave
Fayetteville, AR 72703
Phone (479) 521-8260

114 E Sunbridge Dr
Fayetteville, AR 72703
Phone (479) 463-2597

1111 Maplewood Rd
Harrison, AR 72601
Phone (870) 741-5001

1420 Highway 62 65 N
Harrison, AR 72601
Phone (870) 741-2600

115 Orendorff Ave
Harrison, AR 72601
Phone (870) 741-3438

202 Tims Ave
Harrison, AR 72601
Phone (870) 741-7667

624 Hospital Dr
Mountain Home, AR 72653
Phone (870) 424-1000

Interoperability endpoints

  • Direct secure messaging: kevin.jackson@bhcawp.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CIGHBD

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1144291907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 HIGHWAY 62 65 N",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726011959",
            "telephone_number": "479-741-3600",
            "fax_number": "870-741-4482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 HIGHWAY 62 65 N",
            "city": "HARRISON",
            "state": "AR",
            "postal_code": "726011959",
            "telephone_number": "479-741-3600",
            "fax_number": "870-741-4482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEVIN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-2640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrison, AR

Sources for this page

Verify at the official NPI Registry.