Kenneth D Jackson (NPI# 1295898179, PAC ID# 6103047758) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1295898179 |
| PAC ID by PECOS | 6103047758 |
| Professional Enrollment ID | I20170717002900 |
| Full Name | Kenneth D Jackson |
| Organization Legal Name | PRIME HEALTHCARE KANSAS CITY - PHYSICIAN SERVICES LLC |
| Address |
5721 W 119th St Overland Park KS 66209-3722 |
| Phone Number | 9134986000 |
| Gender | M |
| Medical School | UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE |
| Graduation Year | 2005 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 7315267325 |
| Number of Group Practice Members | 63 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 260085 | ST JOSEPH MEDICAL CENTER |
| 170182 | MENORAH MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 930 Carondelet Dr, Kansas City, MO 64114-4698 | PRIME HEALTHCARE KANSAS CITY - PHYSICIAN SERVICES LLC | |
| 5721 W 119th St, Overland Park, KS 66209-3722 | 9134986000 | PRIME HEALTHCARE KANSAS CITY - PHYSICIAN SERVICES LLC |
| Organization Legal Name | PRIME HEALTHCARE KANSAS CITY - PHYSICIAN SERVICES LLC |
| Physicians | 53 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Elizabeth C Gatrost | Nurse Practitioner | Prime Healthcare Kansas City - Physician Services LLC | 100 Nw Mock Ave, Suite 200, Blue Springs, MO 64014-2500 |
| Lorna A Mccartney | Nurse Practitioner | Prime Healthcare Kansas City - Physician Services LLC | 11901 Wornall Rd, Kansas City, MO 64145-1007 |
| Andrea Rose | Nurse Practitioner | Prime Healthcare Kansas City - Physician Services LLC | 10601 Quivira Rd, Overland Park, KS 66215-2310 |
| Tammy L Osborn | Nurse Practitioner | Prime Healthcare Kansas City - Physician Services LLC | 205 Nw R D Mize Rd, Suite 400, Blue Springs, MO 64014-2527 |
| Maggie M Ngar | Family Medicine | Prime Healthcare Kansas City - Physician Services LLC | 302 Se Salem St, Oak Grove Medical Clinic, Oak Grove, MO 64075-9299 |
| John M Holkins | Cardiovascular Disease (cardiology) | Prime Healthcare Kansas City - Physician Services LLC | 3200 Ne Ralph Powell Rd, Kansas City Cardiology, Lees Summit, MO 64064-2301 |
| James Alfred Dangelo | Family Medicine | Prime Healthcare Kansas City - Physician Services LLC | 930 Carondelet Dr, Kansas City, MO 64114-4698 |
| Jacqueline L Shearer | Nurse Practitioner | Prime Healthcare Kansas City - Physician Services LLC | 801 Nw St Mary Dr, 101 Family Medical Care Associates, Kansas City, MO 64014-2539 |
| Parveen Kumar Khosla | Neurology | Prime Healthcare Kansas City - Physician Services LLC | 206 Nw Mock Dr, 200 St Joseph Specialty Clinic, Blue Springs, MO 64014-2530 |
| Laura B Ferguson | Nurse Practitioner | Prime Healthcare Kansas City - Physician Services LLC | 203 Nw R D Mize Rd, 200 Kansas City Cardiology, Blue Springs, MO 64014-2546 |
| Street Address |
5721 W 119TH ST |
| City | OVERLAND PARK |
| State | KS |
| Zip | 66209-3722 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sonya M Jurgens | Certified Registered Nurse Anesthetist (crna) | Anesthesia Associates of Kansas City PC | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Sarah J Clutter | Anesthesiology | Anesthesia Associates of Kansas City PC | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Jeffrey W Brennan | Anesthesiology | Anesthesia Associates of Kansas City PC | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Matthew T Kneidel | Orthopedic Surgery | Signature Medical Group of Kc Pa | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Renee L Mauer | Certified Registered Nurse Anesthetist (crna) | Anesthesia Associates of Kansas City PC | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Douglas B Knox | Family Medicine | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 | |
| Jarrett S Lefberg | Emergency Medicine | Nall Emergency Physicians LLC | 5721 W 119th St, Overland Park, KS 66209-3722 |
| Ann R Squire | Certified Registered Nurse Anesthetist (crna) | Anesthesia Associates of Kansas City PC | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Bertram W Maidment Iii | Radiation Oncology | Tri Pa | 5721 W 119th St, Menorah Medical Center, Overland Park, KS 66209-3722 |
| Adam M Skinner | Emergency Medicine | Nall Emergency Physicians LLC | 5721 W 119th St, Overland Park, KS 66209-3722 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shane Bisson | Chiropractic | Catalyst Health Center, Pa | 12100 State Line Rd, Leawood, KS 66209-1201 |
| Marcus S Juracek | Chiropractic | Catalyst Health Center, Pa | 12100 State Line Rd, Leawood, KS 66209-1201 |
| David Adam Boender | Chiropractic | Catalyst Health Center, Pa | 12100 State Line Rd, Leawood, KS 66209-1201 |
| Kenneth A Bono | Optometry | 12116 State Line Rd, Leawood, KS 66209-1254 | |
| Mary P Marshall | Psychologist, Clinical | 2221 W 124th St, Leawood, KS 66209-1305 | |
| William J Nowack | Neurology | Remote Neuromonitoring Physicians PC | 12417 Howe Dr, Leawood, KS 66209-1451 |
| Nelopher Hathiary | Internal Medicine | 12720 State Line Rd, Leawood, KS 66209-1619 | |
| Deborah R Hellinger | Diagnostic Radiology | Brfhh Monroe LLC | 13213 Overbrook Rd, Leawood, KS 66209-1628 |
| Michael J Reilly | Emergency Medicine | Kansas City Community Hospital LLC | 13200 State Line Rd, Leawood, KS 66209-1701 |
| Anne Marie B Hall | Emergency Medicine | Kansas City Community Hospital LLC | 13200 State Line Rd, Leawood, KS 66209-1701 |
| Find all physicians in zip 66209 | |||
| City | OVERLAND PARK |
| Zip Code | 66209 |
| Specialty | GENERAL SURGERY |
| City + Specialty | OVERLAND PARK + GENERAL SURGERY |
Please comment or provide details below to improve the information on Kenneth D Jackson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.