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

Q: 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.

Q: What is Carl-christian Jackson's specialty?

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

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: August 02, 2026.

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

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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

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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

Medicare Participation & PECOS CMS

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

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.

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)