NPIMap

Individual provider Active NPI

Kevan Patrick McCullum, APRN

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1114533825
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3015146 Issued in KY
Practice address
908 Dupont Rd
Louisville, KY 40207-4602
Phone
(502) 749-7909
NPI assigned
Sep 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3015146 KY Primary

Addresses

Primary practice location

908 Dupont Rd
Louisville, KY 40207-4602

Mailing address

PO Box 909
Louisville, KY 40201-0909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20201021002687 KY Practitioner - Nurse Practitioner 4486074929 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SN Kentuckiana Rehab, LLCGroup PAC ID 1254671464, shared by 19 NPIs, 339 clinicians
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

12613 Taylorsville Rd
Suite 118
Louisville, KY 40299-5496
Phone (502) 267-1480

7430 Jefferson Blvd
Suite 200
Louisville, KY 40219-6159
Phone (502) 966-8675

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3015146KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. CurrentSince Feb 1, 2023 Accepting new patients
Community Medical Associates, Inc. Family Current Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Sep 29, 2020 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Sep 29, 2020 Accepting new patients
Community Medical Associates, Inc. CurrentSince Feb 1, 2023 Accepting new patients
University of Louisville Research Foundation Past Accepting new patients
Community Medical Associates, Inc. Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

908 DuPont Rd
Louisville, KY 40207
Phone (502) 559-1855

7430 Jefferson Blvd
#200
Louisville, KY 40219
Phone (502) 966-8675

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Interoperability endpoints

  • Direct secure messaging: kmccullum249416@direct.nortonhealthcare.org

Organizations & group practices 8

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1114533825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 DUPONT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074602",
            "telephone_number": "502-749-7909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLUM",
        "first_name": "KEVAN",
        "middle_name": "PATRICK",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3015146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.