CARL-CHRISTIAN ANDREW JACKSON MD
NPI 1235355173
Surgery - Pediatric Surgery in Providence, RI
NPI Status: Active since April 18, 2007
Contact Information
2 DUDLEY ST STE 190
PROVIDENCE, RI
ZIP 02905
Phone: (401) 228-0623
Fax: (401) 868-2319
- Individual
- Male
- Surgery
- Pediatric Surgery
- PECOS Enrolled
About CARL-CHRISTIAN JACKSON
This page provides the complete NPI Profile along with additional information for Carl-christian Jackson, a provider established in Providence, Rhode Island with a medical specialization in Surgery, focusing in pediatric surgery . The healthcare provider is registered in the NPI registry with number 1235355173 assigned on April 2007. The practitioner's primary taxonomy code is 2086S0120X with license number MD18790 (RI). The provider is registered as an individual and his NPI record was last updated one year ago.
- NPI
- 1235355173
- Provider Name
- CARL-CHRISTIAN ANDREW JACKSON MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 2 DUDLEY ST STE 190 PROVIDENCE, RI 02905
- Location Phone
- (401) 228-0623
- Location Fax
- (401) 868-2319
- Mailing Address
- 15 LASALLE SQUARE PROVIDENCE, RI 02903
- Mailing Phone
- (401) 444-3239
- Is Sole Proprietor?
- No
- Enumeration Date
- 04-18-2007
- Last Update Date
- 11-26-2025
- Code Navigator
Location Map
Secondary Locations
- 750 Washington St Tufts-NEMC #344
Boston, MA 02111
(617) 636-5025 - 725 Albany Street, Suite 8C Shapiro Building
Boston, MA 02118
(617) 414-5131
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Surgery Pediatric Surgery
- Taxonomy Code
- 2086S0120X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MD18790
- License State
- RI
- Taxonomy Description
- A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 208600000X | Allopathic & Osteopathic Physicians | Surgery | 036-106668 (IL) |
| 2 | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | 231415 (MA) |
| 3 | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | A88272 (CA) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 00A882720 | MEDICAID (05) | CA |
Medicare Participation & PECOS Enrollment Status
Carl-christian Jackson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1235355173, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 9 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1235355173, enumerated as an "individual" on April 18, 2007.
The provider is located at 2 DUDLEY ST STE 190 PROVIDENCE, RI 02905 and the phone number is (401) 228-0623.
Surgery with taxonomy code 2086S0120X and a focus in Pediatric Surgery.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
