CARL-CHRISTIAN ANDREW JACKSON (MD) – Surgery Physician, NPI 1235355173
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CARL-CHRISTIAN ANDREW JACKSON (MD)
725 Albany Street, Suite 8C
Shapiro Building
Boston, MA 02118
Phone: (617) 414-5131
Fax: (617) 414-3806
Type: Location
750 Washington St
Tufts-NEMC #344
Boston, MA 021111526
Phone: (617) 636-5025
Type: Location
750 WASHINGTON ST
TUFTS-NEMC #344
BOSTON, MA 021111526
Phone: (617) 636-5025
Type: Mailing
15 LASALLE SQUARE
PROVIDENCE, RI 02903
Phone: (401) 444-3239
Type: Mailing
2 DUDLEY ST STE 190
PROVIDENCE, RI 029053248
Phone: (401) 228-0623
Fax: (401) 868-2319
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-11-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070914000131 | I | Pediatric Medicine | MA | TBD |
| I20221129000235 | I | Pediatric Medicine | RI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 02118)
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