NPIMap

Organization Active NPI

Philip K McCullough MD SC

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1003017864
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PHILIP K MCCULLOUGH MD SC
Practice address
201 E Huron St
Suite 11-100
Chicago, IL 60611-3197
Phone
(312) 695-3680
Fax
(312) 926-3709
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Philip K McCullough, MDNPI 1396701371
Title
President
Phone
(312) 695-3680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X IL Primary

Addresses

Primary practice location

201 E Huron St
Suite 11-100
Chicago, IL 60611-3197

Mailing address

201 E Huron St
Suite 11-100
Chicago, IL 60611-3197
Phone (312) 695-3680

Other identifiers 1

IdentifierTypeStateIssuer
01635513OtherILBCBSIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003017864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E HURON ST",
            "address_2": "SUITE 11-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113197",
            "telephone_number": "312-695-3680",
            "fax_number": "312-926-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E HURON ST",
            "address_2": "SUITE 11-100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113197",
            "telephone_number": "312-695-3680",
            "fax_number": "312-926-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP K MCCULLOUGH MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-695-3680",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "01635513",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.