Active NPI
Mathew R McCullough, PA-C
- Medical Physician Assistant
- Delta, CO
National Provider Identifier
1184189425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA.0006103
- Practice address
- 1250 Valley View Dr
Delta, CO 81416-3138 - Phone
- (970) 874-8981
- Fax
- (855) 299-7586
- NPI assigned
- Jan 31, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PA.0006103 | CO | |
| Medical Physician Assistant | 363AM0700X | PA.0006103 | CO | Primary |
Addresses
Primary practice location
1250 Valley View Dr
Delta, CO 81416-3138
Mailing address
PO Box 529
Olathe, CO 81425-0529
Phone (970) 323-6141
Other practice location 1
1010 Rio Grande Ave
Montrose, CO 81401-4831
Phone (970) 497-3333
Other practice location 2
308 Main St
Olathe, CO 81425-0529
Phone (970) 323-6141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1010 S Rio Grande Ave
Montrose, CO 81401-4831
Phone (970) 497-3333
1250 Valley View Dr
Delta, CO 81416-3138
Phone (970) 874-8981
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.0006103 | CO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olathe Community Clinic Inc | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- mathew.mccullough.1@19850.direct.athenahealth.com
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Olathe, CO
- NPI 1770834244
Family Medicine
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Rural Acute Care Hospital
- Delta, CO
- NPI 1417935446
-
- Community Based Hospice Care Agency
- Delta, CO
- NPI 1326646886
-
- Community Based Hospice Care Agency
- Grand Junction, CO
- NPI 1427041227
-
- Community Based Hospice Care Agency
- Montrose, CO
- NPI 1811595374
-
- Community Based Hospice Care Agency
- Grand Junction, CO
- NPI 1851990980
-
- General Acute Care Hospital
- Montrose, CO
- NPI 1205822186
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704240000000",
"number": "1184189425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 529",
"city": "OLATHE",
"state": "CO",
"postal_code": "814250529",
"telephone_number": "970-323-6141",
"fax_number": "855-299-8071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 VALLEY VIEW DR",
"city": "DELTA",
"state": "CO",
"postal_code": "814163138",
"telephone_number": "970-874-8981",
"fax_number": "855-299-7586"
}
],
"practiceLocations": [
{
"address_1": "1010 Rio Grande Ave",
"address_purpose": "LOCATION",
"city": "Montrose",
"state": "CO",
"postal_code": "814014831",
"country_code": "US",
"telephone_number": "970-497-3333",
"fax_number": "855-299-7837",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "308 Main St",
"address_purpose": "LOCATION",
"city": "Olathe",
"state": "CO",
"postal_code": "814250529",
"country_code": "US",
"telephone_number": "970-323-6141",
"fax_number": "855-299-8071",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "MATHEW",
"middle_name": "R",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-31",
"last_updated": "2024-01-03",
"certification_date": "2024-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "PA.0006103",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CO",
"license": "PA.0006103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Delta, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.