Kyli Ann McCullough-Gracia, FNP- BC, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71015167A Issued in IN

Practice address

610 N Sawyer Rd
Kendallville, IN 46755-2566

Phone

(260) 347-5592

NPI assigned

Oct 17, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Kyli Ann McCullough Former name

Medicare fee-for-service enrollment

Enrolled in IN, OH2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Internal Medicine Associates, PCGroup PAC ID 7113830688, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Hospitals and Wellness Centers Hospital, Bryan, OH, CCN 360121
• Community Hospitals and Wellness Centers Hospital, Montpelier, OH, CCN 361327
• Van Wert County Hospital Hospital, Van Wert, OH, CCN 360071
• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

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 and National Provider Directory roles.

• Northeast Internal Medicine Associates, PC

  • Internal Medicine Physician
  • Lagrange, IN
  • NPI 1174518500

  OH

  Medicare reassignment Care Compare group NPD
• Northeast Internal Medicine Associates, PC

  • Primary Care Nurse Practitioner
  • Lagrange, IN
  • NPI 1366859779
  NPD (past)

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

• Parkview Hospital, Inc.

  dba Parkview Regional Medical Center

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation
• Community Hospitals and Wellness Centers

  • Critical Access Hospital
  • Montpelier, OH
  • NPI 1275575227
  Care Compare affiliation
• Community Hospitals and Wellness Centers

  • General Acute Care Hospital
  • Bryan, OH
  • NPI 1962458521
  Care Compare affiliation
• Van Wert County Hospital Association

  dba Van Wert Health

  • General Acute Care Hospital
  • Van Wert, OH
  • NPI 1942267760
  Care Compare affiliation

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1467234187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 236",
            "city": "LAGRANGE",
            "state": "IN",
            "postal_code": "467610236",
            "telephone_number": "260-463-2133",
            "fax_number": "260-463-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N SAWYER RD",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467552566",
            "telephone_number": "260-347-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH-GRACIA",
        "first_name": "KYLI",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP- BC, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-17",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0034654",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71015167A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLI",
            "last_name": "MCCULLOUGH",
            "middle_name": "ANN",
            "prefix": "MISS",
            "credential": "RDN, LD, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Olivia Martin, RBT
• Cassandra Layne Mason
• Abigail Masters
• Rachel Brynn McBride-Alves, LCSW
• Tiffany McComb
• Richard Allen McKinney
• Christopher McMaken, RBT
• Madison Foye McNaughton
• Jennifer Renee Mertz-Turner, LMHC, MAC
• Molly Miles

• Family Nurse Practitioner in Kendallville, IN
• Providers in Kendallville, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.