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RICHARD E JACKSON PA-C
NPI 1174587505
Physician Assistant - Surgical in Port Charlotte, FL

Active since April 13, 2006PECOS EnrolledAccepts Medicare Assignment
21260 OLEAN BLVD STE 200, PORT CHARLOTTE, FL 33952(941) 625-4270(941) 625-1751 Get Directions Write a Review

NPPES record last updated: September 9, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 9, 2020, May 10, 2019 (2 updates tracked since 2019).

About Richard E Jackson Pa-c NPPES

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

RICHARD E JACKSON PA-C (NPI 1174587505) is an individual surgical provider in Port Charlotte, Florida, licensed in Florida (PA2962) and active in the NPI registry since April 2006. He is enrolled in Medicare PECOS, is affiliated with Sarasota Memorial Hospital, and is a graduate of Other (1992).

NPPES Registry Identity

NPI1174587505
Entity TypeIndividualMale
Primary Taxonomy363AS0400X
Provider Legal NameRICHARD E JACKSONCredential: PA-C
Location Address21260 OLEAN BLVD STE 200Port Charlotte, FL 33952-6742
Mailing Address21260 Olean Blvd Ste 200Port Charlotte, FL 33952-6742 · (941) 625-4270 · Fax (941) 625-1751
Phone(941) 625-4270
Fax(941) 625-1751
Sole ProprietorYes
Medical School CMSOtherGraduated 1992
Enumeration DateApril 13, 2006
Last NPPES UpdateSeptember 9, 20202 updates tracked since enumeration
NPPES CertifiedSeptember 9, 2020
✔ NPI 1174587505 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in FL · PA2962
21260 OLEAN BLVD STE 200, Port Charlotte, FL 33952
Open in Google Maps ↗

Other Identifiers 1

Medicaid290761500FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed, Oscar Health Maintenance Organization of Florida.Insurance ›

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

Richard E Jackson Pa-c 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 ID3577573211
PECOS Enrollment IDI20060426000303
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.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Sarasota Memorial Hospital

Acute Care Hospitals · Sarasota, FL
5/5 CMS rating
OwnershipGovernment - Hospital District or Authority
CMS Certification Number100087
Location1700 S Tamiami TrlSarasota, FL 34239 · Sarasota County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 3

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

MICHAEL BAYS D.O.
Internal Medicine (Gastroenterology)
21260 OLEAN BLVD STE 200
PORT CHARLOTTE, FL 33952
Charlotte County (941) 625-4270
DR. CHRISTOPHER L FINLEY D.O.
Surgery
21260 OLEAN BLVD STE 200
PORT CHARLOTTE, FL 33952
Charlotte County (941) 235-9361
ERIN ELIZABETH ALONSO NP
Nurse Practitioner
21260 OLEAN BLVD STE 200
PORT CHARLOTTE, FL 33952
Charlotte County (941) 625-4270

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 Richard Jackson's NPI number?

The NPI number for Richard Jackson is 1174587505. It was assigned to this individual provider in the NPPES registry on April 13, 2006.

Where is Richard Jackson located?

Richard Jackson practices at 21260 Olean Blvd Ste 200, Port Charlotte, FL 33952. The listed phone number is (941) 625-4270.

What is Richard Jackson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Richard Jackson enrolled in Medicare?

Yes. Richard 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.

What insurance does Richard Jackson accept?

Health plans from AvMed and Oscar Health Maintenance Organization of Florida list Richard Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Richard Jackson affiliated with any hospitals?

According to CMS data, Richard Jackson is affiliated with Sarasota Memorial Hospital.

When was this NPI record last updated?

The NPPES record for Richard Jackson was last updated on September 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.