Carl E. Jackson, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35057489 Issued in OH

Practice address

386 Medway Rd
Highland Heights, OH 44143-3734

Phone

(440) 953-1898

Fax

(440) 460-0749

NPI assigned

Aug 30, 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 OH, CO, ND, WY4 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 4

Specialty

General Surgery

Education

Howard University College of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverton Physician Practices, LLCGroup PAC ID 8426954496, 12 clinicians

St. Joseph'S Hospital and Health CenterGroup PAC ID 0547177560, shared by 3 NPIs, 157 clinicians

River Valley Physicians LLCGroup PAC ID 3971506932, 56 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sagewest Health Care Hospital, Riverton, WY, CCN 530008
• CHI St Alexius Health Dickinson Hospital, Dickinson, ND, CCN 351336
• University Hospitals Portage Medical Center Hospital, Ravenna, OH, CCN 360078

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FBJFBA
• Direct secure messaging: cjackson37806@ehrdirect.uhhospitals.org

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.

• River Valley Physicians, LLC

  • Multi-Specialty Clinic/Center
  • East Liverpool, OH
  • NPI 1891756870
  Medicare reassignment Care Compare group NPD
• Special Hands LLC

  • Surgery Physician
  • Warrensville Heights, OH
  • NPI 1235474347
  Medicare reassignment NPD Authorized official
• Riverton Physician Practices, LLC

  • Emergency Medicine Physician
  • Riverton, WY
  • NPI 1205875614
  Medicare reassignment Care Compare group
• Promedica Central Physicians

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1043270150

  Surgery

  Medicare reassignment NPD
• Montrose Memorial Hospital, Inc

  • Emergency Medicine Physician
  • Montrose, CO
  • NPI 1528083771
  Medicare reassignment NPD
• St Joseph'S Hospital and Health Center

  • Clinic/Center
  • Dickinson, ND
  • NPI 1730464108
  Medicare reassignment NPD
• St Joseph'S Hospital and Health Center

  • Critical Access Hospital
  • Dickinson, ND
  • NPI 1992947956
  Medicare reassignment NPD
• Special Hands, LLC

  • Surgery Physician
  • Warrensville Heights, OH
  • NPI 1417171273
  NPD (past) Authorized official
• Promedica Central Physicians

  • Durable Medical Equipment & Medical Supplies
  • Toledo, OH
  • NPI 1669068482
  NPD
• Montrose Memorial Hospital, Inc

  • Diagnostic Radiology Physician
  • Montrose, CO
  • NPI 1437997947
  NPD
• Montrose Memorial Hospital, Inc

  • Surgery Physician
  • Montrose, CO
  • NPI 1831953264
  NPD
• St Joseph'S Hospital and Health Center

  • Rural Health Clinic/Center
  • Beach, ND
  • NPI 1669491262
  NPD

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

• Robinson Health System, Inc.

  • General Acute Care Hospital
  • Ravenna, OH
  • NPI 1043641897
  Care Compare affiliation
• Riverton Memorial Hospital LLC

  • Rural Acute Care Hospital
  • Lander, WY
  • NPI 1245337286
  Care Compare affiliation
• St Joseph'S Hospital and Health Center

  • Critical Access Hospital
  • Dickinson, ND
  • NPI 1992947956
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493683200000",
    "number": "1831208768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "386 MEDWAY RD",
            "city": "HIGHLAND HEIGHTS",
            "state": "OH",
            "postal_code": "441433734",
            "telephone_number": "440-953-1898",
            "fax_number": "440-460-0749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 MEDWAY RD",
            "city": "HIGHLAND HEIGHTS",
            "state": "OH",
            "postal_code": "441433734",
            "telephone_number": "440-953-1898",
            "fax_number": "440-460-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARL",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2017-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35057489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0881247",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Hyr Medical Inc
• Infinity Medical Transportation
• Kelly Jackson
• Raizy Jacobovitch, M. ED, BCBA, COBA
• Rechama Jacobovitch, MS SPED
• Jessica James
• Deborah Louse Johnson, D.C.

• Surgery Physician in Highland Heights, OH
• Providers in Highland Heights, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.