Charles William Jackson, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G35311 Issued in CA

Practice address

17122 Beach Blvd
Suite 102
Huntington Beach, CA 92647-5992

Phone

(714) 847-6545

Fax

(714) 847-6547

NPI assigned

May 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678
• Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Charles W Jackson MD Inc

  • General Practice Physician
  • Huntington Beach, CA
  • NPI 1851594006
  Medicare reassignment NPD Authorized official
• Ameer F Moussa MD Inc

  • Internal Medicine Physician
  • Laguna Hills, CA
  • NPI 1942191796
  NPD (past)

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

• Hoag Memorial Hospital Presbyterian

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1518951300
  Care Compare affiliation
• Orange Coast Memorial Medical Center

  • General Acute Care Hospital
  • Fountain Valley, CA
  • NPI 1497702575
  Care Compare affiliation

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280448000000",
    "number": "1083662845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17122 BEACH BLVD",
            "address_2": "SUITE 102",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926475992",
            "telephone_number": "714-847-6545",
            "fax_number": "714-847-6547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17122 BEACH BLVD",
            "address_2": "SUITE 102",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926475992",
            "telephone_number": "714-847-6545",
            "fax_number": "714-847-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2010-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G35311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G353110",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Veronica Sezanov Ivelia
• Marifel Antonette Ivers
• Kevin J Ivey, M.D.
• Komala Iyengar, M.D.
• Devon Jackett
• Jeannine Jenat Jackson
• Krysten Ashley Jackson, P.T.
• Regan Nicole Jacobs
• Jace Douglas Jacobsen
• Padmini Jadeja, PT

• General Practice Physician in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.