Individual provider Active NPI

Jennifer Lee Botelho, CNM

  • Student in an Organized Health Care Education/Training Program
  • Saint Paul, MN
National Provider Identifier
1114741444
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
3900 Bethel Dr
Saint Paul, MN 55112-6902
Phone
(651) 638-6400
NPI assigned
Nov 13, 2024
Last updated
Nov 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

3900 Bethel Dr
Saint Paul, MN 55112-6902

Mailing address

3900 Bethel Dr
Saint Paul, MN 55112-6902
Phone (651) 638-6400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250702000485 MA Practitioner - Certified Nurse Midwife (CNM) 1850804881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

543 N St
New Bedford, MA 02740-2782
Phone (508) 973-2008

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. Current Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Apr 27, 2025 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Apr 27, 2025 Accepting new patients
Southcoast Hospitals Group, Inc Past Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

543 North St
New Bedford, MA 02740
Phone (508) 973-2208

Interoperability endpoints

  • Direct secure messaging: jbotelho82564@direct.southcoast.org

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 1

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": "1731456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1114741444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 BETHEL DR",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551126902",
            "telephone_number": "651-638-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 BETHEL DR",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551126902",
            "telephone_number": "651-638-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTELHO",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-13",
        "last_updated": "2024-11-13",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.