Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jackson Mark Bennett

Individual provider Diagnostic Radiology Physician · NPI 1366070328

Jackson Mark Bennett is a Diagnostic Radiology in Roseville, Minnesota. Graduated from Baylor College of Medicine in 2020, 6 years ago. Practices with The Medical College of Wisconsin Inc, a 2,093-clinician group and accepts Medicare assignment. Licensed in Minnesota, North Dakota and Wisconsin.

Years since qualifying
6
Trained at
Baylor College of Medicine
Licensed in
MN, ND, WI
In the registry since
2020
Specialties on file
3
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Practice location Address checks out

2355 Hwy 36 W Ste 100
Roseville, MN 55113
Phone: (651) 292-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 77424 (WI)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 81981 (MN)
Diagnostic Radiology Physician Taxonomy 2085R0202X · Licence 24149 (ND)

Record details

NPI number1366070328
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 27, 2020
Last updated in NPPESJuly 7, 2026
Certification dateJuly 7, 2026
Mailing address2355 Hwy 36 W, Ste 100, Roseville, MN 55113

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolBAYLOR COLLEGE OF MEDICINE
Graduated 2020 (6 years in practice)
Group practice The Medical College Of Wisconsin Inc — 2093 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations16 on file with Medicare

Other providers in Roseville