Charles Mark Jackson, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

E-9270 Issued in AR

Practice address

3 E Appleby Rd Ste 201
Fayetteville, AR 72703-3158

Phone

(479) 404-1100

Fax

(479) 404-1101

NPI assigned

May 4, 2010

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

Medicare fee-for-service enrollment

Enrolled in AR

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

Urology

Education

Louisiana State University School of Medicine in New Orleans, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Washington Regional Medical SystemGroup PAC ID 8820995434, 238 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjackson23119@washingtonregional.direct-ci.com

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.

• Washington Regional Medical System

  • Urology Physician
  • Fayetteville, AR
  • NPI 1205073657
  Medicare reassignment Care Compare group NPD
• Washington Regional Medical System

  • Family Medicine Physician
  • Farmington, AR
  • NPI 1275839011
  NPD

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

• Washington Regional Medical Center

  • General Acute Care Hospital
  • Fayetteville, AR
  • NPI 1083609150
  Care Compare affiliation

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

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1255659082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 E APPLEBY RD STE 201",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033158",
            "telephone_number": "479-404-1100",
            "fax_number": "479-404-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 E APPLEBY RD STE 201",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033158",
            "telephone_number": "479-404-1100",
            "fax_number": "479-404-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-04",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "AR",
            "license": "E-9270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Cole White DDS PA
• Tara J Jackson-Farmer
• Amber Adney Jackson, LCSW
• Carol Jackson, LISW - S, LICDC
• Charles David Jackson, MD
• Edward Leslie Jackson, M.D.
• Holly Jackson, DPT
• Kaitlin Jackson, MHPP
• Laura Lynn Jackson, PA-C
• Scott M Jackson, M.D.

• Urology Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Urology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.