Connor McCullough

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

16816-24 Issued in WI

Practice address

1515 Park Ave
Columbus, WI 53925-2402

Phone

(920) 623-2200

NPI assigned

Jun 12, 2024

Last updated

Jun 12, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prairie Ridge Health IncGroup PAC ID 6800791484, 70 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/a87187e5-fe2f-447e-bf32-4eeb3954a735/

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.

• Prairie Ridge Health, Inc.

  • Critical Access Hospital
  • Columbus, WI
  • NPI 1154403657
  Medicare reassignment Care Compare group NPD
• Prairie Ridge Health Inc.

  dba Prairie Ridge Health Clinic-Sun Prairie

  • Family Medicine Physician
  • Sun Prairie, WI
  • NPI 1699534545
  NPD
• Prairie Ridge Health, Inc.

  • Orthopaedic Surgery Physician
  • Columbus, WI
  • NPI 1912329335
  NPD
• Prairie Ridge Health, Inc.

  • Orthopaedic Surgery Physician
  • Beaver Dam, WI
  • NPI 1093137416
  NPD (past)

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1346082021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "CONNOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16816-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arlene G. Lukin, M.S., CCC-SLP
• Mabie Pharmacy, LLC (Forward Pharmacy of Columbus)
• Elise M Malzer, MD
• Amy Mannes, OTR
• Asghar Marwat, M.D.
• Lydia Marie McKee, RN
• Alyssa Catherine Meier, MS SLP
• Sydney Mikulas, PT, DPT
• Colin Tolentino Millar, MD
• Kendra Minick

• Physical Therapist in Columbus, WI
• Providers in Columbus, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.