Mary A McCullough, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN097885 Issued in MO

Practice address

753 Pointe Basse Dr
Ste Genevieve, MO 63670-1820

Phone

(573) 883-4477

Fax

(573) 883-4472

NPI assigned

Jan 15, 2007

Last updated

Apr 18, 2013By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Ste Genevieve County Memorial Hospital

  • Critical Access Hospital
  • Ste Genevieve, MO
  • NPI 1073587655
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  dba Ste Genevieve Surgical Care

  • Surgery Physician
  • Ste Genevieve, MO
  • NPI 1619026580
  Medicare reassignment NPD
• Ste Genevieve County Memorial Hospital

  dba Family Heath Care Pointe Basse

  • Rural Health Clinic/Center
  • Ste Genevieve, MO
  • NPI 1801817416
  Medicare reassignment NPD
• Analytical Pathology Services LTD

  • Anatomic Pathology & Clinical Pathology Physician
  • Saint Louis, MO
  • NPI 1558343673
  NPD
• Ste Genevieve County Memorial Hospital

  dba Ste Genevieve Specialty Clinic

  • Medical Specialty Clinic/Center
  • Ste Genevieve, MO
  • NPI 1508293226
  NPD

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366243200000",
    "number": "1396896510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636700366",
            "telephone_number": "573-883-4477",
            "fax_number": "573-883-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 POINTE BASSE DR",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636701820",
            "telephone_number": "573-883-4477",
            "fax_number": "573-883-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MARY",
        "middle_name": "A",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2013-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "RN097885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CC8331",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591649108",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip Francis Loida, D.D.S.
• Kaitlyn Elizabeth Lukefahr, OD
• Ginger G Luse, MCD,SLP-CCC
• Renee L. Luthy, PTA
• Erica K Mazurkiewicz, LPC
• Mark A McKenzie, R.PH
• Vicki L. McKiel, LPC
• Caitlin McMullen, OTR
• Dalles S Merriman
• Anthony James Meyer

• Adult Health Nurse Practitioner in Ste Genevieve, MO
• Providers in Ste Genevieve, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.