NPIMap

Individual provider Active NPI

Russell Wade McCullough, DO

  • Gastroenterology Physician
  • Lees Summit, MO
National Provider Identifier
1346223468
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2001006773 Issued in MO
Practice address
3601 NE Ralph Powell Rd
Lees Summit, MO 64064-2357
Phone
(816) 251-1200
Fax
(816) 251-1280
NPI assigned
Nov 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2001006773 MO Primary

Addresses

Primary practice location

3601 NE Ralph Powell Rd
Lees Summit, MO 64064-2357

Mailing address

3601 NE Ralph Powell Rd
Lees Summit, MO 64064-2357
Phone (816) 251-1200

Other identifiers 1

IdentifierTypeStateIssuer
209336205MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040826000360 MO Practitioner - Gastroenterology 1052386851 Reassigns benefits to 2 organizations
I20050919000492 KS Practitioner - GastroenterologyPractitioner - Internal Medicine 1052386851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Kansas City College of Medicine and Surgery, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Health Specialists LLCGroup PAC ID 9739494832, 69 clinicians

Practice addresses (Care Compare)

10787 Nall Ave
100 College Park Surgicenter
Overland Park, KS 66211-1373
Phone (816) 554-3838

110 NE Saint Lukes Blvd
Suite 530
Lees Summit, MO 64086-6075
Phone (816) 554-3838

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy147
Upper gastrointestinal (GI) endoscopy for acid reflux163

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2001006773MOMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bates County Memorial Hospital CurrentSince Apr 1, 2019 Accepting new patients
Mawd Pathology Group Inc Current Accepting new patients
Bates County Memorial Hospital Current Accepting new patients
Summit Gastroenterology LLC Gastroenterology CurrentSince Sep 28, 2018 Accepting new patients
Mawd Pathologists, LLC Current Accepting new patients
Bates County Memorial Hospital CurrentSince Apr 1, 2019 Accepting new patients
Midwest Gastroenterology Partners PC Gastroenterology PastSince Jun 1, 2008 Accepting new patients

Locations

7820 W 165th St
Overland Park, KS 66223
Phone (913) 232-9846

615 W Nursery St
Butler, MO 64730
Phone (660) 200-2004

5830 NW Barry Rd
Kansas City, MO 64154
Phone (816) 880-6441

110 NE Saint Lukes Blvd
Ste 530
Lees Summit, MO 64086

Interoperability endpoints

  • Direct secure messaging: russell.mccullough.1@15058.direct.athenahealth.com
  • Direct secure messaging: russellwademcculloughdo@westglenga.allscriptsdirect.net

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346223468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642357",
            "telephone_number": "816-251-1200",
            "fax_number": "816-251-1280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642357",
            "telephone_number": "816-251-1200",
            "fax_number": "816-251-1280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "RUSSELL",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2001006773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209336205",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lees Summit, MO

Sources for this page

Verify at the official NPI Registry.