Charles J. McMullin Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD117270 Issued in MO

Practice address

300 Foxhead Shores Dr
Linn Creek, MO 65052-2563

Phone

(573) 480-4721

NPI assigned

Aug 31, 2006

Last updated

Jun 21, 2011By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• US Health Dept of Health & Human Services

  • Rural Health Clinic/Center
  • Poplar, MT
  • NPI 1972694602

  TX

  Medicare reassignment NPD
• U S Health Dept of Health & Human Services

  dba Lodge Grass Clinic

  • Critical Access Hospital
  • Lodge Grass, MT
  • NPI 1750410395
  NPD
• U S Health Dept of Health & Human Services

  • General Acute Care Hospital
  • Browning, MT
  • NPI 1861409955
  NPD
• Medexpress Urgent Care PLLC-Morgantown

  • Urgent Care Clinic/Center
  • Morgantown, WV
  • NPI 1235138280
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1215049788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FOXHEAD SHORES DR",
            "city": "LINN CREEK",
            "state": "MO",
            "postal_code": "650522563",
            "telephone_number": "573-480-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FOXHEAD SHORES DR",
            "city": "LINN CREEK",
            "state": "MO",
            "postal_code": "650522563",
            "telephone_number": "573-480-4721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMULLIN",
        "first_name": "CHARLES",
        "middle_name": "J.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "MD117270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205428204",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angel R. Heberg, LPC
• Mark A Kassebaum, LPC
• Christina James Landry, LPC
• Brook Lupplace, RN
• Jennifer Wren Matthews, RN
• Alison Meinecke, MS, PLPC
• Ria Newcomb, LPC
• Anita Pinson, LPC, RPT
• Coralee Prettyman
• Brenda Kay Thebeau

• Specialist in Linn Creek, MO
• Providers in Linn Creek, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.

Verify at the official NPI Registry.