NPIMap

Individual provider Active NPI

Tina M Botelho, MD

  • Internal Medicine Physician
  • Mount Pleasant, SC
National Provider Identifier
1023044245
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25344 Issued in SC
Practice address
550 Long Point Rd # 100
Mount Pleasant, SC 29464-8000
Phone
(843) 606-9199
Fax
(843) 718-2858
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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 25344 SC Primary

Addresses

Primary practice location

550 Long Point Rd # 100
Mount Pleasant, SC 29464-8000

Mailing address

550 Long Point Rd # 100
Mount Pleasant, SC 29464-8000
Phone (843) 606-9199

Other identifiers 7

IdentifierTypeStateIssuer
A913OtherSCTINA BOTELHO MD PTAN ASSOCIATED LEGACY INTERNAL MEDICINE LLC
P00202158OtherSCRR MEDICARE
P00802342OtherSCRR MEDICARE
253442MedicaidSC
AA8570A913OtherSCLEGACY INTERNAL MEDICINE LLC--GROUP PTAN
571020809012OtherSCBCBS SC
571020809058OtherSCTRICARE SC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20040915000939 SC Practitioner - Internal Medicine 1456328749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical University of South Carolina College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

498 Wando Park Blvd
Suite 500
Mount Pleasant, SC 29464-7963
Phone (843) 606-9199

Hospital & facility affiliations

  • Amedisys Home Health of Charleston East Home health agency, Charleston, SC, CCN 427027
  • Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104
  • Novant Health East Cooper Medical Center Hospital, Mount Pleasant, SC, CCN 420089
  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Trident Medical Center Hospital, Charleston, SC, CCN 420079
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25344SCMDInternal Medicine Physician

Practice roles (4 of 5)

OrganizationSpecialtyStatusNew patients
Legacy Internal Medicine LLC Internal Medicine CurrentSince Feb 2, 2012 Accepting new patients
Coastal Inpatient Physicians, LLC Internal Medicine Past Accepting new patients
Greenville Health System Past Accepting new patients
Lowcountry Medical Associates Internal Medicine Past Accepting new patients

Locations

498 Wando Park Blvd
Ste 500
Mt Pleasant, SC 29464
Phone (843) 216-8160

550 Long Point Rd
Ste 100
Mt Pleasant, SC 29464
Phone (843) 416-8718

9275 Medical Plaza Dr
Ste D
North Charleston, SC 29406
Phone (843) 410-4499

Networks

  • devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1

Interoperability endpoints

  • Direct secure messaging: tina.botelho.1@19636.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19636/brand/1/csg/1/fhir/r4

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1023044245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 LONG POINT RD # 100",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294648000",
            "telephone_number": "843-606-9199",
            "fax_number": "843-718-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 LONG POINT RD # 100",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294648000",
            "telephone_number": "843-606-9199",
            "fax_number": "843-718-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTELHO",
        "first_name": "TINA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "25344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TINA BOTELHO MD PTAN ASSOCIATED LEGACY INTERNAL MEDICINE LLC",
            "identifier": "A913",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00202158",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00802342",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253442",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGACY INTERNAL MEDICINE LLC--GROUP PTAN",
            "identifier": "AA8570A913",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SC",
            "identifier": "571020809012",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE SC",
            "identifier": "571020809058",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.