Kevin Michael McCullough, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4394 Issued in SC

Practice address

601 S Sutton Rd
Ste 101
Fort Nill, SC 29715

Phone

(803) 328-6306

Fax

(803) 909-6451

NPI assigned

Nov 7, 2017

Last updated

Oct 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC, SC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

OrthocarolinaGroup PAC ID 2062316821, 288 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Medical Center Hospital, Rock Hill, SC, CCN 420002

Merit-based Incentive Payment System (MIPS)

Final score

94 of 100Reported as apm

Quality

81.63

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Orthocarolina

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1497704217

  SC

  Medicare reassignment Care Compare group
• Orthocarolina

  • Orthopaedic Surgery Physician
  • Indian Land, SC
  • NPI 1619641453

  Physician Assistant

  NPD
• Orthocarolina, PA

  • Orthopaedic Surgery Physician
  • Concord, NC
  • NPI 1700185998

  Physician Assistant

  NPD
• Orthocarolina

  • Orthopaedic Surgery Physician
  • Charlotte, NC
  • NPI 1104843978

  Physician Assistant

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amisub of South Carolina, Inc.

  dba Piedmont Medical Center

  • General Acute Care Hospital
  • Rock Hill, SC
  • NPI 1457382483
  Care Compare affiliation

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1285147793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 PARK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282092290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S SUTTON RD",
            "address_2": "STE 101",
            "city": "FORT NILL",
            "state": "SC",
            "postal_code": "29715",
            "telephone_number": "803-328-6306",
            "fax_number": "803-909-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-07",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-07689",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285147793",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3507PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.