Timothy McCullough, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

R3L73 Issued in MO

Practice address

1000 E Cherry St
Troy, MO 63379-1513

Phone

(636) 528-3221

NPI assigned

Sep 16, 2005

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 IL

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

Interoperability endpoints

• Direct secure messaging: tmccullough135328@direct.carenet.org

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.

• Southeastern Emergency Physicians of Memphis LLC

  • Emergency Medicine Physician
  • Alton, IL
  • NPI 1437105277
  Medicare reassignment NPD
• Mercy Hospital South

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1568481984

  Emergency Medicine

  NPD (past)
• SSM Health Care St. Louis

  dba SSM Health St. Joseph Hospital - St. Charles Physician Billing

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922
  NPD (past)

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1275528184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790129",
            "address_2": "DEPT EC",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631790129",
            "telephone_number": "800-968-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E CHERRY ST",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633791513",
            "telephone_number": "636-528-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-16",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "R3L73",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206007619",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Manning
• Mark Jay Beckwith (Beckwith Pharmacy)
• Taylor Laray Martin, DC
• Bradley James Massey, D.O.
• Rebecca Ann Materniak, LPC, NCC
• Destany Danielle McDaniel, LCSW
• Kathleen Anne McKean, DNP
• Kim Dawn McMillian, APRN
• Nicole Marie McNeil, LPC
• Virginia Ann Mennemeyer, DDS, MS

• Emergency Medicine Physician in Troy, MO
• Providers in Troy, MO by specialty
• Emergency Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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.