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CARL-CHRISTIAN ANDREW JACKSON MD
NPI 1235355173
Surgery - Pediatric Surgery in Providence, RI

Active since April 18, 2007PECOS Enrolled
2 DUDLEY ST STE 190, PROVIDENCE, RI 02905(401) 228-0623(401) 868-2319 Get Directions Write a Review

NPPES record last updated: November 26, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Nov 26, 2025, Sep 8, 2022 (2 updates tracked since 2022).

About Carl-christian Andrew Jackson Md NPPES

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

CARL-CHRISTIAN ANDREW JACKSON MD (NPI 1235355173) is an individual pediatric surgery provider in Providence, Rhode Island, licensed in Rhode Island (MD18790) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1235355173
Entity TypeIndividualMale
Primary Taxonomy2086S0120X
Provider Legal NameCARL-CHRISTIAN ANDREW JACKSONCredential: MD
Location Address2 DUDLEY ST STE 190Providence, RI 02905-3248
Mailing Address15 Lasalle SquareProvidence, RI 02903 · (401) 444-3239
Phone(401) 228-0623
Fax(401) 868-2319
Sole ProprietorNo
Enumeration DateApril 18, 2007
Last NPPES UpdateNovember 26, 20252 updates tracked since enumeration
NPPES CertifiedNovember 26, 2025
✔ NPI 1235355173 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySurgery · Pediatric SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0120X
Licenses✔ Licensed in RI · MD18790✔ Licensed in MA · 231415
Definition
A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
Also ListedSurgeryTaxonomy 208600000X · License 036-106668 (IL)
Also ListedThoracic Surgery (Cardiothoracic Vascular Surgery)Taxonomy 208G00000X · License A88272 (CA)
2 DUDLEY ST STE 190, Providence, RI 02905
Open in Google Maps ↗

Secondary Practice Locations 2

Location 1725 Albany Street, Suite 8C, Shapiro BuildingBoston, MA 02118 · Phone (617) 414-5131 · Fax (617) 414-3806
Location 2750 Washington St, Tufts-NEMC #344Boston, MA 02111-1526 · Phone (617) 636-5025

Other Identifiers 1

Medicaid00A882720CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Taro Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Carl-christian Andrew Jackson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignments

5

Medicare enrollment records show Carl-christian Jackson reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Lifespan Physician Group, Inc.
0.5 mi
General Practice
593 EDDY ST
Providence, RI 02903
  • Reassigned Medicare billing, Rhode Island enrollment
  • 1,372 clinicians in this Medicare group
NPI 1407116643 (401) 444-6779
University Surgical Associates, Inc.
14 mi
Surgery
2 DUDLEY ST STE 470
Providence, RI 02905
  • Reassigned Medicare billing, Rhode Island enrollment
  • 99 clinicians in this Medicare group
NPI 1376589895 (401) 272-1800
Lifespan Physician Group Of Massachusetts Inc
19 mi
Family Medicine
2007 BAY ST
Taunton, MA 02780
  • Reassigned Medicare billing, Massachusetts enrollment
  • 547 clinicians in this Medicare group
NPI 1235957713 (774) 409-2009
Pratt Pediatric Associates Inc
41 mi
Pediatrics
800 WASHINGTON ST, BOX 1013
Boston, MA 02111
  • Reassigned Medicare billing, Massachusetts enrollment
  • 202 clinicians in this Medicare group
NPI 1477590511 (617) 636-5000
Pratt Surgical Associates Inc
41 mi
Surgery
800 WASHINGTON ST, BOX 1013
Boston, MA 02111
  • Reassigned Medicare billing, Massachusetts enrollment
  • 72 clinicians in this Medicare group
NPI 1912944182 (617) 636-5000

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

Other Providers at the Same Location NPPES 9

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

KRISTEN LEIGH KLIMM PA-C
Physician Assistant (Surgical)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 421-1939
KELSEY VAN HOUSEN PA-C
Physician Assistant
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 421-1939
ARTUR CHERNOGUZ MD
Surgery (Pediatric Surgery)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 228-0576
JOSHUA NATHANAEL HONEYMAN M.D.
Surgery (Pediatric Surgery)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 228-0576
DR. JULIE MONTEAGUDO M.D.
Surgery (Pediatric Surgery)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 228-0580
MAKAYLA LOURENCO NP
Nurse Practitioner (Pediatrics)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 421-1939
DR. SAMANTHA LYNN AHLE M.D.
Surgery (Pediatric Surgery)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 421-1939
DR. PETER KIM MD
Surgery (Pediatric Surgery)
2 DUDLEY ST STE 190
PROVIDENCE, RI 02905
Providence County (401) 553-8341

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 Carl-christian Jackson's NPI number?

The NPI number for Carl-christian Jackson is 1235355173. It was assigned to this individual provider in the NPPES registry on April 18, 2007.

Where is Carl-christian Jackson located?

Carl-christian Jackson practices at 2 Dudley St Ste 190, Providence, RI 02905. The listed phone number is (401) 228-0623.

What is Carl-christian Jackson's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Pediatric Surgery, with taxonomy code 2086S0120X.

Is Carl-christian Jackson enrolled in Medicare?

Yes. Carl-christian Jackson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Carl-christian Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Carl-christian Jackson reassigns Medicare benefits to 5 organizations: Lifespan Physician Group, Inc. (Providence, RI), University Surgical Associates, Inc. (Providence, RI), Lifespan Physician Group Of Massachusetts Inc (Taunton, MA), Pratt Pediatric Associates Inc (Boston, MA) and Pratt Surgical Associates Inc (Boston, MA). Each 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 Carl-christian Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Carl-christian Jackson accept?

Health plans from Taro Health list Carl-christian 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.

When was this NPI record last updated?

The NPPES record for Carl-christian Jackson was last updated on November 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.