Madelaine Cathleen McCullough, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

61169119 Issued in WA

Practice address

8419 Kerbaugh Rd NE
Olympia, WA 98516-9349

Phone

(303) 359-1730

NPI assigned

Jun 10, 2006

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Health Stop LLC

  dba SmartCare Family Medical Centers

  • Clinic/Center
  • Aurora, CO
  • NPI 1649329830
  NPD (past)
• Jefferson Center for Mental Health

  dba Blue Spruce Pharmacy

  • Community/Retail Pharmacy
  • Lakewood, CO
  • NPI 1861574642
  NPD (past)

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693785600000",
    "number": "1225070923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17950 PRESTON RD",
            "address_2": "STE 250",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752525793",
            "telephone_number": "972-354-5720",
            "fax_number": "972-354-5747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8419 KERBAUGH RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985169349",
            "telephone_number": "303-359-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MADELAINE",
        "middle_name": "CATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "61169119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25954555",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole R McCowan, MASSAGE PRACTITIONER
• Grace Gabrielle McCown
• Carol Jean McCulloch, RPH
• Edward Francis McCullough, D.C.
• Lisa McCullough, D.C.
• Sarah Rachel McCullough, MA60135663
• Deana Marie McCusker
• Crystal Shanell McDaneld
• Alyssa McDaniel, ARNP
• McDonald Dentistry

• Medical Physician Assistant in Olympia, WA
• Providers in Olympia, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.