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

Q: 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.

Q: What is Charles Jackson's specialty?

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

Q: 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.

Active since May 04, 2006PECOS EnrolledAccepts Medicare Assignment

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: October 25, 2026.

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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 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, billing reassignment, and ordering and referring status from CMS.

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.

Medicare Billing Reassignment

Medicare enrollment records show Charles Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Charles W Jackson MD Inc

Same address

General Practice

17122 BEACH BLVD, STE. 102
Huntington Beach, CA 92647

Reassigned Medicare billing, California enrollment
Medicare enrollment name: Charles W Jackson M D Inc

NPI 1851594006 (714) 847-6545

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Which organization bills Medicare for Charles Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Charles Jackson reassigns Medicare benefits to Charles W Jackson MD Inc (Huntington Beach, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Charles Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

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.