NPIMap

Individual provider Active NPI

Charles Andrew Jackson, M.D.

  • Family Medicine Physician
  • Marshall, AR
National Provider Identifier
1720003247
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-0979 Issued in AR
Practice address
2263 Hwy 65 North
Marshall, AR 72650
Phone
(870) 448-5733
NPI assigned
Jul 13, 2006
Last updated
Mar 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E-0979 AR Primary

Addresses

Primary practice location

2263 Hwy 65 North
Marshall, AR 72650

Mailing address

2263 Hwy 65 North
Marshall, AR 72650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091222000660 AR Practitioner - Family Practice 3577603513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2263 Hwy 65 N
Marshall, AR 72650-7660
Phone (870) 448-5733

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Boston Mountain Rural Health Center, Inc CurrentSince Nov 2, 2020 Accepting new patients
Boston Mountain Rural Health Center Inc Current Accepting new patients
Boston Mountain Rural Health Center, Inc CurrentSince Nov 2, 2020 Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients

Locations

934 N Gaskill St
Huntsville, AR 72740
Phone (479) 738-5500

106 Westwood Dr
Marshall, AR 72650
Phone (870) 448-3455

2263 Highway 65 N
Marshall, AR 72650
Phone (870) 741-6065

Interoperability endpoints

  • Direct secure messaging: charles.jackson@bmrhc.eclinicaldirectplus.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1720003247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2263 HWY 65 NORTH",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "72650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2263 HWY 65 NORTH",
            "city": "MARSHALL",
            "state": "AR",
            "postal_code": "72650",
            "telephone_number": "870-448-5733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2021-03-18",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-0979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, AR

Sources for this page

Verify at the official NPI Registry.