Kim Leslie McCullough, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

KM405465 Issued in MI

Practice address

550 Osborn Blvd
Suite 2600
Sault Sainte Marie, MI 49783-1899

Phone

(906) 635-1048

Fax

(906) 635-3103

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

University of Michigan Medical School, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Chippewa County War Memorial Hospital Hospital, Sault Ste Marie, MI, CCN 230239

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

• Mymichigan Medical Center Sault

  • General Acute Care Hospital
  • Sault Sainte Marie, MI
  • NPI 1295756948
  Care Compare affiliation

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266796800000",
    "number": "1194777680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 OSBORN BLVD",
            "address_2": "SUITE 2600",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831899",
            "telephone_number": "906-635-1048",
            "fax_number": "906-635-3103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 OSBORN BLVD",
            "address_2": "SUITE 2600",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831899",
            "telephone_number": "906-635-1048",
            "fax_number": "906-635-3103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KIM",
        "middle_name": "LESLIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2010-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "KM405465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "382967127",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2698385",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carmine Mazzuca, ACNPC-AG
• Jonathan McBain
• Lillian M McBroom, LMSW
• John McCoy, PHARMACIST
• Rachael Lee McCoy, D.C.
• Lindsey McCullough
• Robert McElhaney, M.D.
• Catherine McGrath, M.S., OTRL
• Mary V McKay, LLMSW
• Ann Marie McKelvie

• Surgery Physician in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; 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.

Verify at the official NPI Registry.