Jessica Nicole McCullough, APRN, FNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

14506 Issued in OH

Practice address

14100 Cedar Rd Ste 390-2
Cleveland, OH 44121-3212

Phone

(216) 905-0099

NPI assigned

Jul 2, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jessica.mccullough.p11@direct.loraincountyhealth.nextgenshare.com
• Direct secure messaging: jmccullough29817@direct.metrohealth.org

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.

• Lorain County Health & Dentistry

  • Clinic/Center
  • Lorain, OH
  • NPI 1215194527
  Medicare reassignment NPD
• University Hospitals Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1669499414
  Medicare reassignment NPD
• The Metrohealth System

  dba Metrohealth Professional Group

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1053353896
  Medicare reassignment
• Change Unlimited LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beachwood, OH
  • NPI 1740811231
  Authorized official Same address or phone
• Lorain County Health & Dentistry

  • Clinic/Center
  • Lorain, OH
  • NPI 1336697184

  Family

  NPD
• Lorain County Health & Dentistry

  dba LCH&D Pharmacy Lorain

  • Community/Retail Pharmacy
  • Lorain, OH
  • NPI 1871304550
  NPD
• The Metrohealth System

  dba Metrohealth Medical Center

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1700828852
  NPD
• Dr. Khalafi, MD, LLC

  • Internal Medicine Physician
  • Beachwood, OH
  • NPI 1417037664
  NPD (past)

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1275730376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2616 EDGEWOOD RD",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441221560",
            "telephone_number": "216-647-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14100 CEDAR RD STE 390-2",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441213212",
            "telephone_number": "216-905-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "APRN, FNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "312983",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "14506",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "14506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0085765",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "2573433",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Ann McCue, BCPP
• Andrew John McCullen, MD
• Sarah McCulloch, P.T.
• Arthur J. McCullough, MD
• Devin Patrick McCullough, D.O.
• Lawrence McCullough, QMHS
• Lydia Nicole McCully
• Nautica McCully
• Charlotte C McCumber, MD
• Mandell McCurdy

• Psychiatric/Mental Health Nurse Practitioner in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.