NPIMap

Individual provider Active NPI

Carl Jackson, PA-C

  • Physician Assistant
  • Tulsa, OK
National Provider Identifier
1902263270
Registry record updated Jan 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 2616 Issued in OK
Practice address
8801 S 101St East Ave
Tulsa, OK 74133-5716
Phone
(918) 579-6090
NPI assigned
Jan 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 2616 OK Primary

Addresses

Primary practice location

8801 S 101St East Ave
Tulsa, OK 74133-5716

Mailing address

22096 S 445TH East Ave
Porter, OK 74454-3239
Phone (918) 625-7927

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX, MO3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20160308000737 OK Practitioner - Physician Assistant 8224334891 Reassigns benefits to 8 organizations
I20220407000420 TX Practitioner - Physician Assistant 8224334891 Reassigns benefits to 1 organization
I20231128002347 MO Practitioner - Physician Assistant 8224334891 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usacs Observation Medicine Services of Oklahoma, LLCGroup PAC ID 9931562956, 203 clinicians
Ies ER Oklahoma LLCGroup PAC ID 5395234678, 135 clinicians
Care Communications LLCGroup PAC ID 8820136724, 33 clinicians
Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians

Practice addresses (Care Compare)

220 S Elm St
Suite 200
Jenks, OK 74037-3701
Phone (918) 403-7060

300 Rockefeller Dr
Muskogee, OK 74401-5075
Phone (918) 684-2101

6161 S Yale Ave
Tulsa, OK 74136-1902
Phone (918) 494-2200

6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3331
Phone (918) 488-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 2616OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Carthage CurrentSince Oct 22, 2023 Accepting new patients
Ies ER Oklahoma LLC CurrentSince Oct 1, 2025 Accepting new patients
Mercy Hospital Carthage CurrentSince Oct 22, 2023 Accepting new patients
Creek Nation Hospital & Clinics CurrentSince Jun 1, 2020 Accepting new patients
Warren Clinic Inc CurrentSince Sep 1, 2017 Accepting new patients
Ahs Southcrest Hospital, LLC Past Accepting new patients

Locations

3116 Medical Park Dr
Carthage, MO 64836
Phone (417) 358-7574

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501

6161 S Yale Ave
#A
Tulsa, OK 74136

6600 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-1805

Dept 1467
Tulsa, OK 74182

10501 E 91st St
Tulsa, OK 74133
Phone (918) 307-6000

Dept 1038
Tulsa, OK 74182

6161 S Yale Ave
Tulsa, OK 74136
Phone (918) 494-2200

10109 E 79th St
Tulsa, OK 74133
Phone (888) 552-6760

6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125

Interoperability endpoints

  • Direct secure messaging: cjackson77516@direct.saintfrancis.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453075200000",
    "number": "1902263270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22096 S 445TH EAST AVE",
            "city": "PORTER",
            "state": "OK",
            "postal_code": "744543239",
            "telephone_number": "918-625-7927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8801 S 101ST EAST AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335716",
            "telephone_number": "918-579-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-18",
        "last_updated": "2016-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "PA 2616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.