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JACKSON CENTER, PA
NPI 1417013707
Dermatology in Naples, FL

Active since December 29, 2006CLIA 10D2076021 · Certificate of Compliance
4500 EXECUTIVE DR STE 300, NAPLES, FL 34119(239) 598-9009(239) 598-5009 Get Directions Write a Review

NPPES record last updated: February 17, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jackson Center, Pa NPPES

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

JACKSON CENTER, PA (NPI 1417013707) is a healthcare organization registered as a dermatology in Naples, Florida and active in the NPI registry since December 2006. The organization holds a CLIA Certificate of Compliance certificate valid through November 13, 2026 and lists Jon Ryan Jackson, President, as its authorized official.

NPPES Registry Identity

NPI1417013707
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameJACKSON CENTER, PA
Location Address4500 EXECUTIVE DR STE 300Naples, FL 34119-8908
Mailing Address4500 Executive Dr Ste 300Naples, FL 34119-8908 · (239) 598-9009 · Fax (239) 598-5009
Phone(239) 598-9009
Fax(239) 598-5009
Organization SubpartNo
Authorized OfficialJon Ryan JacksonPresident · (239) 598-9009
Enumeration DateDecember 29, 2006
Last NPPES UpdateFebruary 17, 2023
NPPES CertifiedFebruary 17, 2023
✔ NPI 1417013707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedPlastic SurgeryTaxonomy 208200000X
4500 EXECUTIVE DR STE 300, Naples, FL 34119
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson Center, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Jackson Center, PA, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Jon Jackson, M.D.
Plastic and Reconstructive Surgery
NPI 1740254978
4500 EXECUTIVE DR STE 300
Naples, FL 34119
(239) 598-9009
✔ PECOS✔ Accepts MedicareSame address
Sharon Jackson, M.D.
Dermatology
NPI 1407820764
4500 EXECUTIVE DR STE 300
Naples, FL 34119
(239) 598-9009
✔ PECOS✔ Accepts MedicareSame address
Andrew Kontos, M.D.
Micrographic Dermatologic Surgery (MDS)
NPI 1427164466
3507 LEE BLVD STE 107
Lehigh Acres, FL 33971
(239) 368-8071
✔ PECOS✔ Accepts Medicare24 mi
Peter Mattei, M.D.
Dermatology
NPI 1013195759
6600 UNIVERSITY PKWY STE 302
Sarasota, FL 34240
(941) 800-5001
✔ PECOS✔ Accepts Medicare88 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 10D2076021

Jackson Center PA, The · Naples, FL
Active · expires Nov 13, 2026
CLIA Number10D2076021
Laboratory TypePhysician Office
Certificate Effective DateNovember 14, 2024
Certificate Expiration DateNovember 13, 2026
Laboratory DirectorDr. Sharon C. Jackson
Laboratory Phone(239) 598-9009
Laboratory LocationJackson Center PA, The4500 Executive Dr, Ste 300, Naples, FL 34119
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Jackson Center, PA's NPI number?

The NPI number for Jackson Center, PA is 1417013707. It was assigned to this organization in the NPPES registry on December 29, 2006.

Where is Jackson Center, PA located?

Jackson Center, PA is located at 4500 Executive Dr Ste 300, Naples, FL 34119. The listed phone number is (239) 598-9009.

What is Jackson Center, PA's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Jackson Center, PA enrolled in Medicare?

Yes. Jackson Center, PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jackson Center, PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Jackson Center, PA, in Dermatology, Micrographic Dermatologic Surgery (MDS) and Plastic and Reconstructive Surgery. A 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 the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Jackson Center, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 10D2076021) is associated with this NPI, valid through November 13, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jackson Center, PA was last updated on February 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.