NPIMap

Individual provider Active NPI

David Roger Chabolla, M.D.

  • Neurology Physician
  • Jacksonville, FL
National Provider Identifier
1245229319
Registry record updated Jul 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME68656 Issued in FL
Practice address
4205 Belfort Rd Ste 1100
Jacksonville, FL 32216-5876
Phone
(904) 450-6300
Fax
(904) 281-5966
NPI assigned
Oct 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X ME68656 FL Primary

Addresses

Primary practice location

4205 Belfort Rd Ste 1100
Jacksonville, FL 32216-5876

Mailing address

3 Shircliff Way
Suite 724
Jacksonville, FL 32204-4786
Phone (904) 308-7959

Other identifiers 3

IdentifierTypeStateIssuer
130012335OtherFLRAILROAD MEDICARE
27473OtherFLBLUECROSS/BLUESHIELD
268609100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080618000242 FL Practitioner - Neurology 8123199262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of California, San Diego School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Vincent'S Ambulatory Care IncGroup PAC ID 2860411188, 303 clinicians

Practice addresses (Care Compare)

4205 Belfort Rd
Jacksonville, FL 32216-1471
Phone (904) 308-7959

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME68656FLMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Jan 1, 2008 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jan 1, 2008 Accepting new patients

Locations

3 Shircliff Way
Ste 724
Jacksonville, FL 32204
Phone (904) 308-7959

3 Shircliff Way
Ste 714
Jacksonville, FL 32204
Phone (904) 305-1350

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

4205 Belfort Rd
Ste 1100
Jacksonville, FL 32216
Phone (904) 296-3103

Interoperability endpoints

  • Direct secure messaging: david.chabolla.1@8967.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564358400000",
    "number": "1245229319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SHIRCLIFF WAY",
            "address_2": "SUITE 724",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044786",
            "telephone_number": "904-308-7959",
            "fax_number": "904-308-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 1100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165876",
            "telephone_number": "904-450-6300",
            "fax_number": "904-281-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHABOLLA",
        "first_name": "DAVID",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2019-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME68656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130012335",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "27473",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268609100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.