Matthew James McCullough, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

Practice address

1300 E City Route 40
Greenville, IL 62246-2501

Phone

(618) 664-1483

NPI assigned

Feb 6, 2007

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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Great Rivers Dental P.C.

  • Clinic/Center
  • Bethalto, IL
  • NPI 1932814720
  NPD Authorized official
• Matthew J McCullough, DMD, 3 LLC

  • Dental Clinic/Center
  • East Alton, IL
  • NPI 1295624948
  NPD Authorized official

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497894307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 WHIPPOORWILL DR",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462766",
            "telephone_number": "618-664-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E CITY ROUTE 40",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462501",
            "telephone_number": "618-664-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marion Eye Centers LTD.
• Mary Elizabeth Massena, LCSW
• Matthew J McCullough DMD PC
• Krystal Marie McClenahan, MPT
• Boyd A. McCracken, M.D.
• Brittany Morgan McKinzie, BA
• Timothy McNeill, LPC
• Lisa Yvonne McNutt, RN
• Medical Services of Southern Illinois
• Howard K Mell, M.D.

• Dentist in Greenville, IL
• Providers in Greenville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.