NPIMap

Individual provider Active NPI

Kenneth G Jackson Jr., MD

  • Family Medicine Physician
  • Clemson, SC
National Provider Identifier
1801183710
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
LL33560 Issued in SC
Practice address
885 Tiger Blvd
Clemson, SC 29631-1480
Phone
(864) 654-2067
Fax
(864) 653-5926
NPI assigned
Jun 30, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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 LL33560 SC Primary

Addresses

Primary practice location

885 Tiger Blvd
Clemson, SC 29631-1480

Mailing address

PO Box 100174
Columbia, SC 29202-3174
Phone (864) 512-5725

Other practice location 1

895 Tiger Blvd
Clemson, SC 29631
Phone (864) 512-7257

Other identifiers 1

IdentifierTypeStateIssuer
335603MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20131121001732 SC Practitioner - Family Practice 1355577354 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anmed HealthGroup PAC ID 1951215243, shared by 12 NPIs, 348 clinicians

Practice addresses (Care Compare)

895 Tiger Blvd
Clemson, SC 29631-1480
Phone (864) 654-6800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL33560SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anmed Health Family Medicine CurrentSince Oct 27, 2014 Accepting new patients
Anmed Health Family Medicine CurrentSince Jul 1, 2014 Accepting new patients
Anmed Health Family Medicine CurrentSince Jul 1, 2014 Accepting new patients
Anmed Health Current Accepting new patients
Anmed Health Past Accepting new patients

Locations

800 N Fant St
Ste A
Anderson, SC 29621
Phone (864) 225-5131

800 N Fant St
Anderson, SC 29621
Phone (864) 512-1000

895 Tiger Blvd
Clemson, SC 29631
Phone (864) 512-4530

885 Tiger Blvd
Clemson, SC 29631
Phone (864) 512-4530

Interoperability endpoints

  • Direct secure messaging: kjackson8043@direct.anmedhealth.net

Organizations & group practices 5

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 51

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

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1801183710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100174",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292023174",
            "telephone_number": "864-512-5725",
            "fax_number": "864-512-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 TIGER BLVD",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296311480",
            "telephone_number": "864-654-2067",
            "fax_number": "864-653-5926"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "895 Tiger Blvd",
            "address_purpose": "LOCATION",
            "city": "Clemson",
            "state": "SC",
            "postal_code": "29631",
            "country_code": "US",
            "telephone_number": "864-512-7257",
            "fax_number": "864-654-7672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KENNETH",
        "middle_name": "G",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-30",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL33560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "335603",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemson, SC

Sources for this page

Verify at the official NPI Registry.