Individual provider Active NPI

Bethanie Lynn McCullough, FNP-BC

  • Family Nurse Practitioner
  • Lansing, MI
National Provider Identifier
1417436676
Registry record updated Aug 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704284537 Issued in MI
Practice address
1200 E Michigan Ave Ste 775
Lansing, MI 48912-1838
Phone
(517) 364-5200
NPI assigned
Aug 8, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704284537 MI Primary

Addresses

Primary practice location

1200 E Michigan Ave Ste 775
Lansing, MI 48912-1838

Mailing address

423 E Elm St
Mason, MI 48854-1721
Phone (401) 575-7754

Other identifiers 1

IdentifierTypeStateIssuer
1447344502OtherMIINDIVIDUAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20180830001616 MI Practitioner - Nurse Practitioner 3779833421 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 E Michigan Ave
Suite 340 University of Michigan Health SP
Lansing, MI 48912-1894
Phone (517) 364-5930

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704284537MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W. Sparrow Hospital Association CurrentSince Mar 1, 2021 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Mar 1, 2021 Accepting new patients
Edward W. Sparrow Hospital Association Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

1200 E Michigan Ave
Ste 775
Lansing, MI 48912
Phone (517) 364-5160

1140 E Michigan Ave
Ste 300
Lansing, MI 48912
Phone (517) 364-5200

1200 E Michigan Ave
Ste 510
Lansing, MI 48912
Phone (517) 364-5184

1200 E Michigan Ave
Ste 340
Lansing, MI 48912
Phone (517) 364-5930

1200 E Michigan Ave
Ste 655
Lansing, MI 48912
Phone (517) 267-2460

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

Organizations & group practices 4

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 3

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": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1417436676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 E ELM ST",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488541721",
            "telephone_number": "401-575-7754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E MICHIGAN AVE STE 775",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121838",
            "telephone_number": "517-364-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "BETHANIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704284537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "1447344502",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.