Lori A McCullough, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

085005433 Issued in IL

Practice address

4500 Memorial Dr
Belleville, IL 62226-5360

Phone

(618) 257-6220

NPI assigned

Apr 8, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Saint Louis University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview Heights Medical Group SCGroup PAC ID 6800784083, 448 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital Hospital, Belleville, IL, CCN 140185
• Alton Memorial Hospital Hospital, Alton, IL, CCN 140002

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.

• Fairview Heights Medical Group SC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1679503668

  IL

  Medicare reassignment Care Compare group NPD (past)
• Emergency Services Midwest SC

  • Emergency Medicine Physician
  • Belleville, IL
  • NPI 1174024806
  Medicare reassignment
• Southeastern Emergency Services of Memphis, P.C.

  • Emergency Medicine Physician
  • Chattanooga, TN
  • NPI 1164454450

  IL

  Medicare reassignment
• North County Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Florissant, MO
  • NPI 1356366934
  NPD (past)

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

• Alton Memorial Hospital

  • Ambulance
  • Alton, IL
  • NPI 1063669117

  Hospital

  Care Compare affiliation
• Alton Memorial Hospital

  • General Acute Care Hospital
  • Alton, IL
  • NPI 1548278476
  Care Compare affiliation
• Protestant Memorial Medical Center, Inc.

  • General Acute Care Hospital
  • Belleville, IL
  • NPI 1982796181
  Care Compare affiliation

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1336312693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 CLAYTON RD",
            "address_2": "STE 110",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631171850",
            "telephone_number": "314-645-4434",
            "fax_number": "314-645-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-257-6220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6400 Clayton Rd",
            "address_2": "Ste 110",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631171850",
            "country_code": "US",
            "telephone_number": "314-645-4434",
            "fax_number": "314-645-3801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 W Highway 50",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622691681",
            "country_code": "US",
            "telephone_number": "618-206-5076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "LORI",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2002001000",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085005433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4500 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mattie McAllister, CRNA
• Brian Timothy McAnulty, CRNA
• Lynette McAnulty
• Jason Christopher McCarthy, M.D.
• Neil McClymont, D.O.
• Caroline McDonald
• Brian L McElaney, MD
• Payton K. McGowen, M.D.
• Sara A McHale, M.D.
• Ashley Taylor McIntyre, FNP-C

• Medical Physician Assistant in Belleville, IL
• Providers in Belleville, IL by specialty
• Medical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.
• 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.