Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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Richard E Jackson, PA-C

Individual provider Surgical Physician Assistant · NPI 1174587505

Richard E Jackson, PA-C is a Physician Assistant in Port Charlotte, Florida. Qualified in 1992, 34 years ago. Practices with Smh Physician Services Inc, a 774-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
34
Licensed in
FL
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

21260 Olean Blvd Ste 200
Port Charlotte, FL 33952-6742
Phone: (941) 625-4270
Fax: (941) 625-1751
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA2962 (FL)

Record details

NPI number1174587505
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedApril 13, 2006
Last updated in NPPESSeptember 9, 2020
Certification dateSeptember 9, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1992 (34 years in practice)
Group practice Smh Physician Services Inc — 774 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Smh Physician Services Inc

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 774 clinicians in the practice; 12 are shown here.

Other providers in Port Charlotte