Philip K McCullough, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036049877 Issued in IL

Practice address

676 N Saint Clair St Ste 1510
Chicago, IL 60611-2995

Phone

(312) 695-3680

Fax

(312) 926-3709

NPI assigned

Apr 26, 2006

Last updated

Jan 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2007 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Philip K McCullough MD SC

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1003017864
  NPD (past) Authorized official
• John P Gerber MD, SC

  • Specialist
  • Chicago, IL
  • NPI 1326237660
  NPD (past)
• Psychiatric Associates SC

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1013005826
  NPD (past)

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1396701371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1510",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112995",
            "telephone_number": "312-695-3680",
            "fax_number": "312-695-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 1510",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112995",
            "telephone_number": "312-695-3680",
            "fax_number": "312-926-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "PHILIP",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036049877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "01635513",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Imari C McCullough
• Kristin M McCullough, DDS
• Lindsay McCullough, M.D.
• Megan McCullough
• Michelle Ann McCullough, L.C.S.W.
• Rex Thomas McCully II, LCSW
• Erin Rebecca McCune
• Plashan L. McCune, MS LPC
• Andrea Claire McCurdy, LCSW
• Karen McCurtis, PHD

• Psychiatry Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.