Active NPI
Barry G McCullough, PA
- Physician Assistant
- Orange Park, FL
National Provider Identifier
1225057151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA1751
- Practice address
- 2140 Kingsley Ave Ste 1
Orange Park, FL 32073-5129 - Phone
- (904) 272-7500
- Fax
- (904) 272-7502
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1751 | FL | Primary |
Addresses
Primary practice location
2140 Kingsley Ave Ste 1
Orange Park, FL 32073-5129
Mailing address
2140 Kingsley Ave Ste 1
Orange Park, FL 32073-5129
Phone (904) 272-7500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2908077-00 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241568000000",
"number": "1225057151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2140 KINGSLEY AVE STE 1",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320735129",
"telephone_number": "904-272-7500",
"fax_number": "904-272-7502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2140 KINGSLEY AVE STE 1",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320735129",
"telephone_number": "904-272-7500",
"fax_number": "904-272-7502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOUGH",
"first_name": "BARRY",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2009-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA1751",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2908077-00",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.