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DR. CHARLES WILLIAM JACKSON M.D.
NPI 1083662845
General Practice in Huntington Beach, CA

Active since May 04, 2006PECOS EnrolledAccepts Medicare AssignmentCLIA 05D0580056 · Microscopy
17122 BEACH BLVD, SUITE 102, HUNTINGTON BEACH, CA 92647(714) 847-6545(714) 847-6547 Get Directions Write a Review

NPPES record last updated: July 30, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Charles William Jackson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHARLES WILLIAM JACKSON M.D. (NPI 1083662845) is an individual general practice provider in Huntington Beach, California, licensed in California (G35311) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS, holds a CLIA Microscopy certificate valid through August 30, 2026, and is a graduate of Other (1976).

NPPES Registry Identity

NPI1083662845
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameDR. CHARLES WILLIAM JACKSONCredential: M.D.
Location Address17122 BEACH BLVD, SUITE 102Huntington Beach, CA 92647-5992
Mailing Address17122 Beach Blvd, Suite 102Huntington Beach, CA 92647-5992 · (714) 847-6545 · Fax (714) 847-6547
Phone(714) 847-6545
Fax(714) 847-6547
Sole ProprietorNo
Medical School CMSOtherGraduated 1976
Enumeration DateMay 4, 2006
Last NPPES UpdateJuly 30, 2010
✔ NPI 1083662845 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in CA · G35311
Definition
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
17122 BEACH BLVD, Huntington Beach, CA 92647
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Other Identifiers 3

Medicaid00G353110CA
Medicare PINDF302ZCA
Medicare UPINA46305CA

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Charles William Jackson M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5496641789
PECOS Enrollment IDI20040224000853
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D0580056

Charles Jackson MD · Huntington Beach, CA
Active · expires Aug 30, 2026
CLIA Number05D0580056
Laboratory TypePhysician Office
Certificate Effective DateAugust 31, 2024
Certificate Expiration DateAugust 30, 2026
Laboratory DirectorCharles W. Jackson
Laboratory Phone(714) 847-6545
Laboratory LocationCharles Jackson MD17122 Beach Blvd, Suite 102, Huntington Beach, CA 92647
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
114 services64 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
67 services56 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
57 services36 patients

Referred Medical Equipment & Supplies CMS DME claims 6

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
9 suppliers27 claims85 services$6.74 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
7 suppliers12 claims16 services$1.13 avg. paid by Medicare
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape B4035
Other-Enteral and Parenteral · category OB006N
1 supplier12 claims360 services$4.84 avg. paid by Medicare
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit B4154
Other-Enteral and Parenteral · category OB006N
1 supplier12 claims4,320 services$0.56 avg. paid by Medicare
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit B4155
Other-Enteral and Parenteral · category OB006N
1 supplier12 claims1,032 services$0.65 avg. paid by Medicare
Iv pole E0776
DME-Other DME · category DE000N
1 supplier12 claims12 services$4.75 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RUBICELI HERNANDEZ NURSE PRACTITIONER
Nurse Practitioner (Family)
17122 BEACH BLVD, SUITE 102
HUNTINGTON BEACH, CA 92647
Orange County (714) 847-6545
LISA HA PT
Physical Therapist
17122 BEACH BLVD, SUITE 101
HUNTINGTON BEACH, CA 92647
Orange County (714) 848-7191
NEW LIFE REHABILITATION, INC.
Physical Therapist
17122 BEACH BLVD, STE 101
HUNTINGTON BEACH, CA 92647
Orange County (714) 848-7191
KARA CHELO PT, DPT
Physical Therapist
17122 BEACH BLVD, #101
HUNTINGTON BEACH, CA 92647
Orange County (714) 848-7191
TERRY M. IMAGAWA, D.D.S., INC.
Dentist (General Practice)
17122 BEACH BLVD, SUITE 201
HUNTINGTON BEACH, CA 92647
Orange County (714) 847-2569
CHARLES W JACKSON MD INC
General Practice
17122 BEACH BLVD, STE. 102
HUNTINGTON BEACH, CA 92647
Orange County (714) 847-6545
MRS. ANDREA LOUISE YOU M.S., P.T.
Physical Therapist
17122 BEACH BLVD, SUITE 101
HUNTINGTON BEACH, CA 92647
Orange County (714) 848-7191

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Jackson's NPI number?

The NPI number for Charles Jackson is 1083662845. It was assigned to this individual provider in the NPPES registry on May 4, 2006.

Where is Charles Jackson located?

Charles Jackson practices at 17122 Beach Blvd Suite 102, Huntington Beach, CA 92647. The listed phone number is (714) 847-6545.

What is Charles Jackson's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Charles Jackson enrolled in Medicare?

Yes. Charles Jackson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Does Charles Jackson hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D0580056) is associated with this NPI, valid through August 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Charles Jackson was last updated on July 30, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.