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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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DR. Charles William Jackson, M.D. is a general practice in Huntington Beach, CA with 48 years of experience. 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.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Injection beneath the skin or into muscle for therapy, diagnosis, or prevention (HCPCS:96372)
  • Destruction of skin growth (HCPCS:17000)

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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther 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: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.