DR. CHARLES WILLIAM JACKSON M.D. NPI 1083662845

NPI Information

  • NPI: 1083662845
  • Provider Name: DR. CHARLES WILLIAM JACKSON, M.D.
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • CLIA Number: 05D0580056
  • Address: 17122 BEACH BLVD
    SUITE 102
    HUNTINGTON BEACH, CA
    ZIP 92647
  • Phone: (714) 847-6545

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NPI Details

DR. Charles William Jackson, M.D. is a general practice in Huntington Beach, CA with 50 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DR. Charles William Jackson, M.D. NPI is 1083662845. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

17122 BEACH BLVD
SUITE 102
HUNTINGTON BEACH, CA
ZIP 92647-992
Phone: (714) 847-6545
Fax: (714) 847-6547

The NPI 1083662845 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 05D0580056 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
  • Established patient office or other outpatient visit, 40-54 minutes (HCPCS:99215)
  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Influenza vaccine split virus, preservative free (HCPCS:90662)
  • Administration of influenza virus vaccine (HCPCS:G0008)

The enumeration date for this NPI number is 5/4/2006 and was last updated on 7/30/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeG35311CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100G353110MEDICAIDCALIFORNIA
2DF302ZMEDICARE PINCALIFORNIA
3A46305MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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