Kenneth Wade Jackson Jr., M.D.

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

License

9801313 Issued in NC

Practice address

15 Skyland Inn Dr FL 2
Arden, NC 28704-7714

Phone

(828) 654-5005

Fax

(828) 654-3257

NPI assigned

May 16, 2006

Last updated

Mar 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fletcher Hospital IncGroup PAC ID 5395658819, 302 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Hendersonville Hospital, Hendersonville, NC, CCN 340023
• Memorial Mission Hospital and Asheville Surgery Ce Hospital, Asheville, NC, CCN 340002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjackson659569@adventhealth.direct-ci.com

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

• Fletcher Hospital Inc.

  dba AdventHealth Hendersonville

  • Rural Acute Care Hospital
  • Hendersonville, NC
  • NPI 1427075027
  Medicare reassignment Care Compare group NPD
• Obhg North Carolina, P.C.

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1124300876
  Medicare reassignment NPD
• Fletcher Hospital Inc

  dba AdventHealth Family Medicine & Behavioral Health Clinic Saluda

  • Rural Health Clinic/Center
  • Saluda, NC
  • NPI 1376371880
  NPD
• Fletcher Hospital Inc.

  dba AdventHealth

  • Family Medicine Physician
  • Hendersonville, NC
  • NPI 1477995124
  NPD
• Shawnee Mission Medical Center Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Merriam, KS
  • NPI 1992735690

  Obstetrics & Gynecology

  NPD (past)

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

• Fletcher Hospital Inc.

  dba AdventHealth Hendersonville

  • Rural Acute Care Hospital
  • Hendersonville, NC
  • NPI 1427075027
  Care Compare affiliation
• Fletcher Hospital Inc.

  dba AdventHealth

  • Family Medicine Physician
  • Hendersonville, NC
  • NPI 1477995124

  Hospital

  Care Compare affiliation
• MH Mission Hospital, LLLP

  dba Mission Hospital

  • General Acute Care Hospital
  • Asheville, NC
  • NPI 1962987677
  Care Compare affiliation

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1487606943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1869",
            "city": "FLETCHER",
            "state": "NC",
            "postal_code": "287321869",
            "telephone_number": "828-687-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SKYLAND INN DR FL 2",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287047714",
            "telephone_number": "828-654-5005",
            "fax_number": "828-654-3257"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Hospital Dr Ste 4A",
            "address_purpose": "LOCATION",
            "city": "Hendersonville",
            "state": "NC",
            "postal_code": "287925246",
            "country_code": "US",
            "telephone_number": "828-650-8077",
            "fax_number": "828-651-0194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KENNETH",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NC",
            "license": "9801313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2169383",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11453742",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "136RM",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89136RM",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Halle Rae Irvine, PHYSICIAN ASSISTANT
• J Henry Eci,Inc.
• J. Romano Medical Enterprise, Inc.
• Nathaniel Jablecki, M.D.
• Jennifer Jackson, OTR
• Mark Edward Jacobs, OD
• Jay Bryner PA-C PLLC
• Kylie Jeffrey, OTR/L
• Nicole A Joers, DPT
• Teresa S Johns, LCSW

• Obstetrics Physician in Arden, NC
• Providers in Arden, NC by specialty
• Obstetrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.