NPIMap

Individual provider Active NPI

Charles W Ampadu, MD

  • Internal Medicine Physician
  • Swansea, IL
National Provider Identifier
1962545269
Registry record updated Sep 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036083270 Issued in IL
Practice address
15 Park PL
Swansea, IL 62226-2918
Phone
(618) 257-0780
Fax
(618) 257-0715
NPI assigned
Feb 15, 2007
Last updated
Sep 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036083270 IL Primary

Addresses

Primary practice location

15 Park PL
Swansea, IL 62226-2918

Mailing address

15 Park PL
Swansea, IL 62226-2918
Phone (618) 257-0780

Other identifiers 1

IdentifierTypeStateIssuer
036083270MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dr.ampadufacp@ampadumed.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071220000588 IL Practitioner - Internal Medicine 3971693474 Reassigns benefits to 1 organization
I20230309000326 MO Practitioner - Internal Medicine 3971693474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adult Internal Medicine Practice LLCGroup PAC ID 9638244494, 3 clinicians

Practice addresses (Care Compare)

15 Park PL
Swansea, IL 62226-2918
Phone (618) 257-0780

3625 Magnolia Ave
Saint Louis, MO 63110-4048
Phone (618) 580-1359

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
23.04 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
76.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036083270ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adult Internal Medicine Practice LLC Internal Medicine CurrentSince Mar 1, 1994 Accepting new patients
15 Park Place LLC Internal Medicine CurrentSince Jul 12, 2020 Accepting new patients
Beauvais Operator LLC Past Accepting new patients
Southern Illinois Regional Wellness Center Past Accepting new patients
Evercare at University LLC PastSince Jul 1, 2024 Accepting new patients

Locations

15 Park Pl
Swansea, IL 62226
Phone (618) 233-9729

15 Park Pl
Ste 1
Swansea, IL 62226
Phone (618) 580-1359

15 Park Pl
Ste 101
Swansea, IL 62226

150 N 27th St
Swansea, IL 62226
Phone (618) 235-6600

3625 Magnolia Ave
Saint Louis, MO 63110
Phone (314) 771-2990

Interoperability endpoints

  • Direct secure messaging: campadum@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evercare of EdwardsvilleEdwardsville, IL, CCN 145555 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2024
Jul 1, 2024
Evercare at UniversityEdwardsville, IL, CCN 145985 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2024
Jul 1, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630886400000",
    "number": "1962545269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PARK PL",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262918",
            "telephone_number": "618-257-0780",
            "fax_number": "618-257-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PARK PL",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262918",
            "telephone_number": "618-257-0780",
            "fax_number": "618-257-0715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMPADU",
        "first_name": "CHARLES",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2021-09-06",
        "certification_date": "2021-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036083270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083270",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dr.ampadufacp@ampadumed.com",
            "affiliation": "N",
            "endpointDescription": "secure email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "secure email address",
            "address_1": "15 Park Pl",
            "city": "Swansea",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622262918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

Verify at the official NPI Registry.