Individual provider Active NPI

Chetan Vagesh Hampole, M.D.

  • Cardiovascular Disease Physician
  • Fleming Island, FL
National Provider Identifier
1659696136
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
ME142908 Issued in FL
Practice address
2310 Village Square Pkwy Ste 204
Fleming Island, FL 32003-6409
Phone
(904) 224-5185
Fax
(904) 376-3202
NPI assigned
Mar 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125-051072 IL
Internal Medicine Physician 207R00000X 35-095464 OH
Internal Medicine Physician 207R00000X ME142908 FL
Cardiovascular Disease Physician 207RC0000X 35-095464 OH
Interventional Cardiology Physician 207RI0011X ME142908 FL
Interventional Cardiology Physician 207RI0011X 35095464 OH
Cardiovascular Disease Physician 207RC0000X ME142908 FL Primary

Addresses

Primary practice location

2310 Village Square Pkwy Ste 204
Fleming Island, FL 32003-6409

Mailing address

PO Box 746652
Atlanta, GA 30374-6652
Phone (904) 202-2092

Other identifiers 2

IdentifierTypeStateIssuer
3025372MedicaidOH
105563400MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200226002482 FL Practitioner - Cardiovascular Disease (Cardiology) 1951522945 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Chicago, Pritzker School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Cardiology, Inc. 98 clinicians

Practice addresses (Care Compare)

1747 Baptist Clay Dr
Suite 320
Fleming Island, FL 32003-8503
Phone (904) 224-5185

Hospital & facility affiliations

  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME142908FLMDInternal Medicine Physician
125-051072ILMDInternal Medicine Physician
35-095464OHMDInternal Medicine Physician
35095464OHMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ecg Associates of Jacksonville P a CurrentSince Mar 23, 2021 Accepting new patients
Baptist Cardiology, Inc. Cardiovascular Disease CurrentSince Apr 1, 2020 Accepting new patients
Baptist Cardiology Inc Cardiovascular Disease PastSince Apr 1, 2020 Accepting new patients

Locations

1747 Baptist Clay Dr
Ste 320
Fleming Island, FL 32003
Phone (904) 224-5185

2310 Village Square Pkwy
Ste 204
Fleming Island, FL 32003
Phone (904) 224-5185

836 Prudential Dr
Ste 1700
Jacksonville, FL 32207
Phone (904) 398-0125

800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000

Interoperability endpoints

  • Direct secure messaging: champole18209@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 3

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 2

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": "1269820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1659696136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746652",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746652",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 VILLAGE SQUARE PKWY STE 204",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320036409",
            "telephone_number": "904-224-5185",
            "fax_number": "904-376-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMPOLE",
        "first_name": "CHETAN",
        "middle_name": "VAGESH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-29",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125-051072",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-095464",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME142908",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35-095464",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME142908",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OH",
            "license": "35095464",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME142908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3025372",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105563400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fleming Island, FL

Sources for this page

Verify at the official NPI Registry.