NPIMap

Individual provider Active NPI

Timothy C Haines, PA-C

  • Medical Physician Assistant
  • Charleston, SC
National Provider Identifier
1699144170
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
3577 Issued in SC
Practice address
1938 Charlie Hall Blvd Unit B
Charleston, SC 29414-6099
Phone
(843) 402-0227
Fax
(843) 402-0232
NPI assigned
Sep 15, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA057825 PA
Medical Physician Assistant 363AM0700X 3577 SC Primary

Addresses

Primary practice location

1938 Charlie Hall Blvd Unit B
Charleston, SC 29414-6099

Mailing address

1938 Charlie Hall Blvd Unit B
Charleston, SC 29414-6099
Phone (843) 402-0227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, SC2 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
I20151019002024 PA Practitioner - Physician Assistant 1254640006 Reassigns benefits to 1 organization
I20201221000244 SC Practitioner - Physician Assistant 1254640006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lowcountry Infectious Diseases PAGroup PAC ID 8527070291, 15 clinicians

Practice addresses (Care Compare)

1938 Charlie Hall Blvd
Unit B
Charleston, SC 29414-6099
Phone (843) 402-0227

1938 Charlie Hall Blvd Unit B
Charleston, SC 29414-6099

Hospital & facility affiliations

  • Roper-St. Francis Home Health Home health agency, Charleston, SC, CCN 427042
  • Amedisys Home Health of Charleston East Home health agency, Charleston, SC, CCN 427027
  • Roper Hospital Hospital, Charleston, SC, CCN 420087
  • Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104
  • Novant Health East Cooper Medical Center Hospital, Mount Pleasant, SC, CCN 420089
  • Musc Medical Center Hospital, Charleston, SC, CCN 420004
  • Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA057825PAMDMedical Physician Assistant
3577SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lowcountry Infectious Diseases PA CurrentSince Feb 1, 2021 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 1, 2015 Accepting new patients
Lowcountry Infectious Diseases PA CurrentSince Feb 1, 2021 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 1, 2015 Accepting new patients

Locations

1250 S Cedar Crest Blvd
Ste 200
Allentown, PA 18103
Phone (610) 402-3701

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

1938 Charlie Hall Blvd
Unit B
Charleston, SC 29414
Phone (803) 402-0227

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 and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1699144170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1938 CHARLIE HALL BLVD UNIT B",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294146099",
            "telephone_number": "843-402-0227",
            "fax_number": "843-402-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1938 CHARLIE HALL BLVD UNIT B",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294146099",
            "telephone_number": "843-402-0227",
            "fax_number": "843-402-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAINES",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-15",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA057825",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "3577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.