Tanna Lynn McCullough, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209006703 Issued in IL

Practice address

2111 Lexington Ave
Lawrenceville, IL 62439-2085

Phone

(618) 943-7216

Fax

(618) 943-7219

NPI assigned

Jul 12, 2007

Last updated

Apr 11, 2012By the provider in NPPES

Sex

Female

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 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

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lawrence County Memorial HospitalGroup PAC ID 7517144249, shared by 4 NPIs, 33 clinicians

Lawrence County Memorial HospitalGroup PAC ID 1850288481, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lawrence County Memorial Hospital Hospital, Lawrenceville, IL, CCN 141344

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Lawrence County Memorial Hospital

  • Critical Access Hospital
  • Lawrenceville, IL
  • NPI 1396024162
  Medicare reassignment NPD
• Lawrence County Memorial Hospital

  • Critical Access Hospital
  • Lawrenceville, IL
  • NPI 1881643401
  Medicare reassignment NPD
• Lawrence County Memorial Hospital

  dba LCMH Primary Care Clinic-RHC

  • Rural Health Clinic/Center
  • Lawrenceville, IL
  • NPI 1811183692
  NPD
• Associated Pathologists, LLC

  dba Associated Pathologists LLC dba PathGroup

  • Anatomic Pathology & Clinical Pathology Physician
  • Nashville, TN
  • NPI 1003863580
  NPD
• Lawrence County Memorial Hospital

  • Critical Access Hospital
  • Lawrenceville, IL
  • NPI 1386744795
  NPD (past)

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

• Lawrence County Memorial Hospital

  • Critical Access Hospital
  • Lawrenceville, IL
  • NPI 1881643401
  Care Compare affiliation

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334102400000",
    "number": "1346449188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 STATE ST",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624391852",
            "telephone_number": "618-943-1000",
            "fax_number": "618-943-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 LEXINGTON AVE",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624392085",
            "telephone_number": "618-943-7216",
            "fax_number": "618-943-7219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "TANNA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-12",
        "last_updated": "2012-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209006703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Jo Marley, RN, BSN
• Emma Jane Marsh
• Jessica Rae Marshall, M.S. CCC-SLP
• Ashley Dawn McAdow, BSW
• Mary McCarter, APRN
• Brianna Mefford
• Jessica Mendenhall
• Reiley Eryn Michels, APRN
• Midwest Ultrasound Services, Inc.
• Helena Miller

• Family Nurse Practitioner in Lawrenceville, IL
• Providers in Lawrenceville, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; 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.