Dr Kenneth Jake Sample, MD - Medicare Internal Medicine in Gravette, AR

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Dr Kenneth Jake Sample, MD is a medicare enrolled "Internal Medicine" physician in Gravette, Arkansas. His current practice location is 1101 Jackson St Sw, Gravette, Arkansas. You can reach out to his office (for appointments etc.) via phone at (479) 787-5221.

Dr Kenneth Jake Sample is licensed to practice in Arkansas (license number E-18299) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699358960.

Contact Information

Dr Kenneth Jake Sample, MD
1101 Jackson St Sw,
Gravette, AR 72736-9121
(479) 787-5221
(479) 787-5613

Map and Direction




Physician's Profile

Full NameDr Kenneth Jake Sample
GenderMale
SpecialityInternal Medicine
Location1101 Jackson St Sw, Gravette, Arkansas
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1699358960
  • Provider Enumeration Date: 05/04/2021
  • Last Update Date: 08/05/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 0244630200
  • Enrollment ID: I20210611002097

Medical Identifiers

Medical identifiers for Dr Kenneth Jake Sample such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1699358960NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207R00000XInternal Medicine E-18299 (Arkansas)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kenneth Jake Sample is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Kenneth Jake Sample, MD
1101 Jackson St Sw,
Gravette, AR 72736-9121

Ph: () -		Dr Kenneth Jake Sample, MD
1101 Jackson St Sw,
Gravette, AR 72736-9121

Ph: (479) 787-5221

Reviews and Comments


Internal Medicine Doctors in Gravette, AR

Drake Hunter Cullum, MD
Internal Medicine
Medicare: Medicare Enrolled
Practice Location: 1101 Jackson St Sw, Gravette, AR 72736
Phone: 479-787-5291    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.