Individual provider Active NPI

Tammy Barnes Gottshalk, FNP-C

  • Nurse Practitioner
  • Charleston, SC
National Provider Identifier
1265584510
Registry record updated Nov 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1473 Issued in SC
Practice address
25 Courtenay Drive
Ashley River Tower
Charleston, SC 29425
Phone
(843) 876-4797
Fax
(843) 876-4989
NPI assigned
Jan 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1473 SC Primary

Addresses

Primary practice location

25 Courtenay Drive
Ashley River Tower
Charleston, SC 29425

Mailing address

PO Box 751461
Charlotte, NC 28275-1461
Phone (843) 792-6200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081028000252 SC Practitioner - Nurse Practitioner 7416015979 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1473SCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medical University Hospital Authority CurrentSince Nov 1, 2014 Accepting new patients
University Medical Associates of the Medical University of South Carol Nurse Practitioner CurrentSince Jul 1, 2017 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Jul 1, 2017 Accepting new patients
Medical University Hospital Authority CurrentSince Nov 1, 2014 Accepting new patients

Locations

25 Courtenay Dr
Charleston, SC 29425
Phone (843) 792-1952

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

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.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415750400000",
    "number": "1265584510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 COURTENAY DRIVE",
            "address_2": "ASHLEY RIVER TOWER",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29425",
            "telephone_number": "843-876-4797",
            "fax_number": "843-876-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTSHALK",
        "first_name": "TAMMY",
        "middle_name": "BARNES",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2014-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "1473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.