NPIMap

Individual provider Active NPI

Kevin McCullum, MD

  • Family Medicine Physician
  • Plattsburgh, NY
National Provider Identifier
1063518975
Registry record updated Feb 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
164868 Issued in NY
Practice address
96 Court St
Plattsburgh, NY 12901-2733
Phone
(518) 562-1080
Fax
(518) 562-3316
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 164868 NY Primary

Addresses

Primary practice location

96 Court St
Plattsburgh, NY 12901-2733

Mailing address

154 Prospect Ave
Plattsburgh, NY 12901-1302
Phone (518) 563-5440

Other identifiers 1

IdentifierTypeStateIssuer
01279267MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100622000668 NY Practitioner - Family Practice 2264563048 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Champlain Valley Physicians Hospital Medical CenterGroup PAC ID 2769396878, 356 clinicians

Practice addresses (Care Compare)

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 561-2000

Hospital & facility affiliations

  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250
  • Meadowbrook Healthcare Nursing home, Plattsburgh, NY, CCN 335438
  • Champlain Valley Physicians Hosp Med Ctr S N F Nursing home, Plattsburgh, NY, CCN 335442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
164868NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Champlain Valley Physicians Hospital Medical Center Family Medicine CurrentSince Apr 6, 2024 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Past Accepting new patients
Champlain Valley Physicians Hospital Medical Center Past Accepting new patients

Locations

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

Interoperability endpoints

  • Direct secure messaging: kmccullum579332@direct.uvmhealth.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Champlain Valley Physicians Hospital Medical CenterPlattsburgh, NY, CCN 335442 Skilled nursing facility Corporate Director
Operational/Managerial Control
Adp of the SNF		 Apr 29, 2024
Apr 29, 2024
Jul 3, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 2

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1063518975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 PROSPECT AVE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011302",
            "telephone_number": "518-563-5440",
            "fax_number": "518-563-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 COURT ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012733",
            "telephone_number": "518-562-1080",
            "fax_number": "518-562-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLUM",
        "first_name": "KEVIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "164868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01279267",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.