Carl-Christian Andrew Jackson, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

MD18790 Issued in RI

Practice address

2 Dudley St Ste 190
Providence, RI 02905-3248

Phone

(401) 228-0623

Fax

(401) 868-2319

NPI assigned

Apr 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA, RI2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjackson29434@tuftsmedicine.direct-ci.com
• Direct secure messaging: carl-christian.jackson@direct-address.net

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.

• Lifespan Physician Group, Inc.

  • General Practice Physician
  • Providence, RI
  • NPI 1407116643

  Surgery

  Medicare reassignment NPD
• University Surgical Associates, Inc.

  • Surgery Physician
  • Providence, RI
  • NPI 1376589895
  Medicare reassignment NPD
• Pratt Pediatric Associates Inc

  • Pediatrics Physician
  • Boston, MA
  • NPI 1477590511
  Medicare reassignment NPD
• Pratt Surgical Associates Inc

  • Surgery Physician
  • Boston, MA
  • NPI 1912944182
  Medicare reassignment NPD
• Lifespan Physician Group of Massachusetts Inc

  • Family Medicine Physician
  • Taunton, MA
  • NPI 1235957713
  Medicare reassignment
• Lifespan Physician Group, Inc.

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1568325678
  NPD
• Rhode Island Hospital

  • Transplant Surgery Physician
  • Providence, RI
  • NPI 1174605208
  NPD
• Lifespan Physician Group, Inc.

  • Psychiatry Physician
  • Providence, RI
  • NPI 1548506793
  NPD (past)
• Rhode Island Hospital

  • Neurology Physician
  • Providence, RI
  • NPI 1902902364
  NPD (past)
• Usc Surgeons, Inc.

  • Surgery Physician
  • Los Angeles, CA
  • NPI 1821034315
  NPD (past)

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1235355173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LASALLE SQUARE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02903",
            "telephone_number": "401-444-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DUDLEY ST STE 190",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053248",
            "telephone_number": "401-228-0623",
            "fax_number": "401-868-2319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Albany Street, Suite 8C",
            "address_2": "Shapiro Building",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02118",
            "country_code": "US",
            "telephone_number": "617-414-5131",
            "fax_number": "617-414-3806",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "750 Washington St",
            "address_2": "Tufts-NEMC #344",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021111526",
            "country_code": "US",
            "telephone_number": "617-636-5025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARL-CHRISTIAN",
        "middle_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A88272",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "RI",
            "license": "MD18790",
            "primary": true
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MA",
            "license": "231415",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-106668",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A882720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J3 Advisory LLC
• Grace Nazaree Jablonski, APRN
• Brianna Maia Jabon, DO
• Moune Jabre Raughley, MD
• Lisa Ellen Jacavone, RN/NP
• Carnell Jackie Jackson, MSW
• Charlotte Jackson, MD
• Chris Jackson, LMHC
• Cynthia Jackson, PH.D.
• Jaissen M Jackson, LMHC

• Pediatric Surgery Physician in Providence, RI
• Providers in Providence, RI by specialty
• Pediatric Surgery Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.