Jerry Russell Penn McCullough

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150.131752 Issued in IL

Practice address

819 Bloomington Rd
Champaign, IL 61820-2101

Phone

(217) 600-7000

NPI assigned

Sep 29, 2026

Last updated

Sep 29, 2026By 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

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1790640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1346154291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 BRIAR LN APT 115",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 BLOOMINGTON RD",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618202101",
            "telephone_number": "217-600-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "JERRY",
        "middle_name": "RUSSELL PENN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-09-29",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.131752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley N McCormick
• Tegan McCormick
• Dawn K McCoy, MD
• Jessica Lynn McCoy
• Ashlyn McCreary
• Tearra McDade
• David McDaniel, LSW
• Hellen G McDonald, LCSW MSW
• Michael McDonald, MHP
• Glenda L McFadden, LPC

• Social Worker in Champaign, IL
• Providers in Champaign, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.