Charles W Jackson MD Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G35311 Issued in CA

Legal business name

CHARLES W JACKSON MD INC

Practice address

17122 Beach Blvd
Ste. 102
Huntington Beach, CA 92647-5992

Phone

(714) 847-6545

Fax

(714) 847-6547

NPI assigned

Jun 6, 2007

Last updated

Jul 28, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charles Jackson, M.D.NPI 1083662845

Title

President

Phone

(714) 847-6545

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles William Jackson, M.D.

  • General Practice Physician
  • Huntington Beach, CA
  • NPI 1083662845
  Medicare reassignment NPD Authorized official
• Rubiceli Hernandez, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Huntington Beach, CA
  • NPI 1114359429
  NPD (past)
• Ameer F. Moussa, M.D.

  • Internal Medicine Physician
  • Huntington Beach, CA
  • NPI 1942436225
  NPD (past)

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1851594006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7630",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926077630",
            "telephone_number": "949-643-3345",
            "fax_number": "949-643-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17122 BEACH BLVD",
            "address_2": "STE. 102",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926475992",
            "telephone_number": "714-847-6545",
            "fax_number": "714-847-6547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES W JACKSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-847-6545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G35311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jeremy Chartier
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• Doris Chastain, LMFT
• Jeanette Chatman

• General Practice Physician in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.