NPIMap

Charles Andrew Jackson, M.D.

Individual provider Active NPI Family Medicine Physician · Marshall, AR

NPI 1720003247 · NPPES record last updated Mar 18, 2021

Key facts

NPI
1720003247
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
E-0979 (AR)
Practice address
2263 Hwy 65 North
Marshall, AR 72650
Phone
(870) 448-5733
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 21

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.

Hospital & facility affiliations 13

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

Medicare Care Compare profile

Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boston Mountain Rural Health Center, Inc (53 clinicians)

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • Centerwell Home Health Home health agency · Harrison, AR · CCN 047803
  • North Arkansas Regional Medical Center Hospital · Harrison, AR · CCN 040017
  • Baxter Health Hospital · Mountain Home, AR · CCN 040027
  • Ozark Health Hospital · Clinton, AR · CCN 041313
  • Conway Regional Medical Center, Inc Hospital · Conway, AR · CCN 040029
  • Mercy Hospital Fort Smith Hospital · Fort Smith, AR · CCN 040062

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

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

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

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

Locations

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

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

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

Interoperability endpoints

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

Specialties & licenses

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

Addresses

Primary practice location

2263 Hwy 65 North
Marshall, AR 72650

Mailing address

2263 Hwy 65 North
Marshall, AR 72650

Other identifiers

IdentifierTypeStateIssuer
080168260OtherRR MEDICARE
130077001MedicaidAR

Other providers in Marshall, AR

All providers in Marshall, AR · Family Medicine Physician in Arkansas

Sources for this page

Verify at the official NPI Registry.