MR. KEVIN W JACKSON (PA-C) – Physician Assistant, NPI 1871986083
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
5,032 PHYSICIAN ASSISTANT in OH
Provider Addresses for MR. KEVIN W JACKSON (PA-C)
1140 S KNOXVILLE AVE STE D
SAINT MARYS, OH 458852609
Phone: (419) 300-1129
Type: Mailing
812 Redskin Trl
Wapakoneta, OH 458958545
Phone: (419) 586-6489
Fax: (419) 586-8509
Type: Location
332 CONGRESS PARK DR
DAYTON, OH 45459
Phone:
Type: Mailing
730 W MARKET STREET
EMERGENCY DEPT
LIMA, OH 45801
Phone: (419) 227-3361
Type: Location
801 PRO DR STE D1
CELINA, OH 458223307
Phone: (419) 586-6489
Fax: (419) 586-8509
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $183.
Total Amount is formed as General ($183) + Research ($0) + Ownership ($0) = $183.
Last reported payment date: 2024-12-04 • Largest payer in this snapshot: Lilly USA, LLC ($39).
Total Amount
$183
General + Research + Ownership
Payments
10
Total payment records
General Amount
$183
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Lilly USA, LLC | $39 |
| Novo Nordisk Inc | $36 |
| PFIZER INC. | $36 |
| ABBVIE INC. | $34 |
| Otsuka America Pharmaceutical, Inc. | $20 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2015-04-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20150413001271 | I | Physician Assistant | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 181 | 169 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 50 | 50 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 29 | 29 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 24 | 22 | $0 |
Insurance plans in this area (ZIP 45885)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Internal Medicine | OH | |
| P A T H O L O G Y | WI | |
| Emergency Medicine | OH | |
| Nurse Practitioner | OH | |
| Internal Medicine, Family Practice | OH | |
| - | OH | |
| - | OH | |
| P A T H O L O G Y | WI | |
| Physician Assistant | OH |
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