MISS CHALOTHORN WANNAPHUT M.D.
NPI 1700576873
Internal Medicine - Hematology & Oncology in Jacksonville, FL

Q: What is Chalothorn Wannaphut's NPI number?

The NPI number for Chalothorn Wannaphut is 1700576873. It was assigned to this individual provider in the NPPES registry on May 11, 2023.

Q: What is Chalothorn Wannaphut's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology & Oncology, with taxonomy code 207RH0003X.

Active since May 11, 2023PECOS Enrolled

4500 SAN PABLO RD S, JACKSONVILLE, FL 32224(904) 953-2000 Get Directions Write a Review

NPPES record last updated: May 19, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 19, 2026, May 5, 2026, Nov 9, 2023 and 1 more (4 updates tracked since 2023).

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About Miss Chalothorn Wannaphut M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS CHALOTHORN WANNAPHUT M.D. (NPI 1700576873) is an individual hematology & oncology provider in Jacksonville, Florida, licensed in Florida (ME179683) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS, maintains a secondary practice location in Honolulu, and is a graduate of Other (2014).

NPPES Registry Identity

NPI1700576873

Entity TypeIndividualFemale

Primary Taxonomy207RH0003X

Provider Legal NameMISS CHALOTHORN WANNAPHUTCredential: M.D.

Location Address4500 SAN PABLO RD SJacksonville, FL 32224-1865

Mailing AddressPo Box 860912Minneapolis, MN 55486-0912

Phone(904) 953-2000

Sole ProprietorNo

Medical School CMSOtherGraduated 2014

Enumeration DateMay 11, 2023

Last NPPES UpdateMay 19, 20264 updates tracked since enumeration

NPPES CertifiedMay 19, 2026

✔ NPI 1700576873 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Hematology & OncologyAllopathic & Osteopathic Physicians

Taxonomy Code207RH0003X

License✔ Licensed in FL · ME179683

Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

4500 SAN PABLO RD S, Jacksonville, FL 32224

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Secondary Practice Location 1

Location 11356 Lusitana Street, University of Hawaii Internal Med, 7th FloorHonolulu, HI 96813 · Phone (808) 586-2890 · Fax (808) 586-2947

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miss Chalothorn Wannaphut M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8921571639

PECOS Enrollment IDI20260624003091

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Chalothorn Wannaphut reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mayo Clinic Jacksonville

Same address

Health Service

4500 SAN PABLO RD S
Jacksonville, FL 32224

Reassigned Medicare billing, Florida enrollment
1,828 clinicians in this Medicare group

NPI 1174143986 (904) 953-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32224 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$171.84 typical visit price

range $56.00 – $171.84

Typical copayment $42.96 (range $14.00 – $42.96)

Most-billed visit code 99205

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE L WALSH PA-C/MPH

Physician Assistant