NPIMap

Individual provider Active NPI

Jerry Wayne Chandler II, D.O.

  • Cardiovascular Disease Physician
  • Jacksonville, FL
National Provider Identifier
1598739856
Registry record updated Oct 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
0102201507 Issued in VA
Practice address
2080 Child St
Jacksonville, FL 32214-5005
Phone
(904) 542-7608
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0102201507 VA
Cardiovascular Disease Physician 207RC0000X 0102201507 VA Primary

Addresses

Primary practice location

2080 Child St
Jacksonville, FL 32214-5005

Mailing address

476 Summerset Dr
Saint Johns, FL 32259-8890
Phone (757) 572-1899

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
I20191230000660 FL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8022249275 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ashchi Heart and Vascular Center PAGroup PAC ID 0941519979, 9 clinicians
Simonmed Imaging Florida LLCGroup PAC ID 6608036108, 302 clinicians

Practice addresses (Care Compare)

3900 University S Blvd a
Jacksonville, FL 32216-4391
Phone (904) 222-6656

476 Summerset Dr
Saint Johns, FL 32259-8890
Phone (480) 306-6949

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
75.71
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ashchi Heart & Vascular Center PA Cardiovascular Disease CurrentSince Dec 5, 2019 Accepting new patients
Simonmed Imaging Florida LLC CurrentSince Jun 12, 2022 Accepting new patients
Simonmed Imaging Florida LLC CurrentSince Jun 12, 2022 Accepting new patients
Bagnoli and Salah Partnership Past Accepting new patients

Locations

20414 N 27th Ave
Ste 150
Phoenix, AZ 85027
Phone (623) 234-2520

3900 University Blvd S
Ste A
Jacksonville, FL 32216
Phone (904) 222-6656

208 W Oak St
Kissimmee, FL 34741
Phone (407) 788-2888

14302 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 975-1111

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: jerrychandler@ahvcpa.allscriptsdirect.net

Organizations & group practices 4

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

Hospital & facility affiliations 3

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": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414540800000",
    "number": "1598739856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476 SUMMERSET DR",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322598890",
            "telephone_number": "757-572-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "904-542-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDLER",
        "first_name": "JERRY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2014-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102201507",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0102201507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.