Active NPI
Paul Edward Cullum, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Columbia, TN
National Provider Identifier
1194748285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- DS3661
- Practice address
- 105 Berrywood Dr
Columbia, TN 38401-6409 - Phone
- (931) 381-7766
- Fax
- (931) 381-2738
- NPI assigned
- Jul 26, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DS3661 | TN | Primary |
Addresses
Primary practice location
105 Berrywood Dr
Columbia, TN 38401-6409
Mailing address
105 Berrywood Dr
Columbia, TN 38401-6409
Phone (931) 381-7766
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3072215 | Other | TN | BLUE CROSS BLUE SHIELD TN |
| 909843 | Other | TN | UNITED CONCORDIA |
| 80-40025 | Other | TN | UNITED HEALTHCARE |
| 0010342 | Other | TN | TENNCARE |
| 909843 | Other | TN | BLUE CROSS BLUE SHIELD PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120131000242 | TN | Practitioner - Oral Surgery | 4183881303 | Practice locations: Columbia, TN |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320969600000",
"number": "1194748285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 BERRYWOOD DR",
"city": "COLUMBIA",
"state": "TN",
"postal_code": "384016409",
"telephone_number": "931-381-7766",
"fax_number": "931-381-2738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 BERRYWOOD DR",
"city": "COLUMBIA",
"state": "TN",
"postal_code": "384016409",
"telephone_number": "931-381-7766",
"fax_number": "931-381-2738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CULLUM",
"first_name": "PAUL",
"middle_name": "EDWARD",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2011-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "TN",
"license": "DS3661",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TN",
"identifier": "3072215",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "909843",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "80-40025",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNCARE",
"identifier": "0010342",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD PA",
"identifier": "909843",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.