Keith Michael McCullough, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1818 Issued in ID

Practice address

700 W Ironwood Dr Ste 175
Coeur D Alene, ID 83814-4401

Phone

(208) 625-6300

Fax

(208) 625-6301

NPI assigned

Sep 19, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiology Associates of North Idaho PAGroup PAC ID 4385635150, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/e8b4f872-6ea1-4b26-a974-041b5fb4c57b/

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.

• Radiology Associates of North Idaho, PA

  • Radiology Clinic/Center
  • Coeur D Alene, ID
  • NPI 1851384416
  Medicare reassignment Care Compare group
• Benewah Community Hospital

  • Rural Health Clinic/Center
  • St Maries, ID
  • NPI 1386632180

  Physician Assistant

  Medicare reassignment NPD
• Bonner General Hospital Inc.

  • Critical Access Hospital
  • Sandpoint, ID
  • NPI 1154563963
  Medicare reassignment NPD
• Kootenai Health, Inc.

  • Psychiatry Physician
  • Coeur D Alene, ID
  • NPI 1174661151
  Medicare reassignment NPD
• Kootenai Health, Inc.

  • Emergency Medicine Physician
  • Coeur D Alene, ID
  • NPI 1235288655
  Medicare reassignment
• Kootenai Health, Inc.

  • Community/Retail Pharmacy
  • Hayden, ID
  • NPI 1235986290
  NPD
• Kootenai Health, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Coeur D Alene, ID
  • NPI 1609925023
  NPD
• Kootenai Health, Inc.

  • Diagnostic Radiology Physician
  • Coeur D Alene, ID
  • NPI 1700918851
  NPD
• Incyte Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Spokane Valley, WA
  • NPI 1326086745
  NPD
• Bonner General Hospital, Inc

  • Gynecology Physician
  • Sandpoint, ID
  • NPI 1992069454
  NPD (past)

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

• Kootenai Health, Inc.

  • General Acute Care Hospital
  • Coeur D Alene, ID
  • NPI 1992798409
  Care Compare affiliation

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754179200000",
    "number": "1447800552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 175",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144401",
            "telephone_number": "208-625-6309",
            "fax_number": "208-625-6310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 175",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144401",
            "telephone_number": "208-625-6300",
            "fax_number": "208-625-6301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2003 Kootenai Health Way",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838146051",
            "country_code": "US",
            "telephone_number": "208-625-6360",
            "fax_number": "208-625-6361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KEITH",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-19",
        "last_updated": "2025-08-03",
        "certification_date": "2025-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmccullough627413@direct.multicare.org",
            "affiliation": "N",
            "address_1": "2003 Kootenai Health Way",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838146051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Ann McCarthy
• Emily Jean McCarty, M.D.
• Stephanie McClelland
• Kyra Nicole McComas, MD
• Brenna Kolokoff McCrummen, M.D.
• Lonnie Earle McCurdie Jr., RPH
• Patrick L. McCurdy, PA-C
• Kimberly McDermott, FNP-BC
• Kaitlyn McDonald, PHARMD
• Shawna Richardson McDonald

• Physician Assistant in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2025; 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.