Charles G Jackson, MD

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

MD00014267 Issued in WA

Practice address

1200 112TH Ave NE
Suite C-210
Bellevue, WA 98004-3732

Phone

(425) 454-2191

Fax

(425) 453-1270

NPI assigned

Jul 27, 2006

Last updated

Jul 7, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Allergy and Asthma Associates PLLC

  • Allergy & Immunology Physician
  • Bellevue, WA
  • NPI 1669746566
  Authorized official Same address or phone

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246924800000",
    "number": "1851305866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980710632",
            "telephone_number": "425-454-2191",
            "fax_number": "425-453-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 112TH AVE NE",
            "address_2": "SUITE C-210",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043732",
            "telephone_number": "425-454-2191",
            "fax_number": "425-453-1270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHARLES",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2009-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "WA",
            "license": "MD00014267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1039247",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate B Jablonski
• Christopher S Jack, MD
• Joy Elaine Jack, CDP
• Amy Jackson
• August Jackson
• Christopher L Jackson, MS, LMHC
• Jerry Michael Jackson, MSW, ACSW
• Kaitlin Josephine Jackson
• Sarah Catherine Jackson, OD
• Taylor Jackson

• Allergy Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Allergy Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.