Individual provider Active NPI

Jessica Mathews McCullough, CRNP

  • Acute Care Nurse Practitioner
  • Mobile, AL
National Provider Identifier
1053540450
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1-106242 Issued in AL
Practice address
5955 Airport Blvd
Mobile, AL 36608
Phone
(251) 633-0573
Fax
(251) 633-7367
NPI assigned
Jul 7, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-106242 AL
Acute Care Nurse Practitioner 363LA2100X 1-106242 AL Primary

Addresses

Primary practice location

5955 Airport Blvd
Mobile, AL 36608

Mailing address

PO Box 7987
Mobile, AL 36670-0987
Phone (251) 633-0573

Other practice location 1

141 Tuscaloosa St
Mobile, AL 36607-3422
Phone (251) 433-3344

Other practice location 2

8725 County Road 64
Daphne, AL 36526-6061
Phone (251) 625-1370

Other identifiers 12

IdentifierTypeStateIssuer
102I502393OtherALMEDICARE
3092229OtherALUHC
512-05477OtherALBCBS
134189MedicaidAL
222576MedicaidAL
9582378OtherALAETNA
P00927530OtherALRR MEDICARE
Z12803OtherALVIVA HEALTH
02482035OtherMSMS MEDICAID
510-49658OtherALBCBS
214094MedicaidAL
512-05479OtherALBCBS

Other names 1

  • Jessica Nicole Brock Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20090820000078 AL Practitioner - Nurse Practitioner 2163576588 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5955 Airport Blvd
Mobile, AL 36608-3135
Phone (251) 633-0573

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.38 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-106242ALMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pulmonary Associates of Mobile PC Current Accepting new patients
Pulmonary Associates of Mobile PC CurrentSince Aug 1, 2009 Accepting new patients
Pulmonary Associates of Mobile PC PastSince Aug 1, 2009 Accepting new patients

Locations

8725 County Road 64
Daphne, AL 36526
Phone (251) 625-1370

5955 Airport Blvd
Mobile, AL 36608
Phone (251) 633-0573

141 Tuscaloosa St
Mobile, AL 36607
Phone (251) 433-3344

6701 Airport Blvd
Ste B135
Mobile, AL 36608
Phone (251) 633-0573

Organizations & group practices 3

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 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": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1053540450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7987",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366700987",
            "telephone_number": "251-633-0573",
            "fax_number": "251-633-7367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 AIRPORT BLVD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "36608",
            "telephone_number": "251-633-0573",
            "fax_number": "251-633-7367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "141 Tuscaloosa St",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366073422",
            "country_code": "US",
            "telephone_number": "251-433-3344",
            "fax_number": "251-433-4052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8725 County Road 64",
            "address_purpose": "LOCATION",
            "city": "Daphne",
            "state": "AL",
            "postal_code": "365266061",
            "country_code": "US",
            "telephone_number": "251-625-1370",
            "fax_number": "251-625-1380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JESSICA",
        "middle_name": "MATHEWS",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-07",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-106242",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-106242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "102I502393",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "3092229",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-05477",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134189",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "222576",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9582378",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00927530",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIVA HEALTH",
            "identifier": "Z12803",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS MEDICAID",
            "identifier": "02482035",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "510-49658",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214094",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "512-05479",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BROCK",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.