Susan Elyse McCullough, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

903762 Issued in MS

Practice address

7736 Airways Blvd
Southaven, MS 38671-5306

Phone

(662) 772-5222

Fax

(662) 772-5957

NPI assigned

Jun 19, 2020

Last updated

Apr 19, 2022By 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 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS, TN2 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, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Baptist Memorial Medical Group, Inc.Group PAC ID 5193610228, 581 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
• Homechoice Health Services - Hernando Home health agency, Hernando, MS, CCN 257034
• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
• Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048

Merit-based Incentive Payment System (MIPS)

Final score

81.87 of 100Reported as group

Quality

64.75

Promoting interoperability

100

Improvement activities

40

Cost

74.81

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smccullough507551@direct.bmhcc.org

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.

• Baptist Memorial Medical Group Inc

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1306089206

  MS

  Medicare reassignment Care Compare group NPD
• Desoto Family Wellness Center, LLC

  • Multi-Specialty Clinic/Center
  • Southaven, MS
  • NPI 1376143024

  Family

  NPD
• Baptist Memorial Medical Group Inc

  dba BMG East Memphis Pharmacy

  • Community/Retail Pharmacy
  • Memphis, TN
  • NPI 1841006129
  NPD

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

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• LHCG Xcviii, LLC

  dba Baptist Home Care & Hospice - North Mississippi

  • Home Health Agency
  • Batesville, MS
  • NPI 1275068959
  Care Compare affiliation
• Suncrest Healthcare of West Tennessee, LLC

  dba Homechoice Health Services

  • Home Health Agency
  • Hernando, MS
  • NPI 1467826958
  Care Compare affiliation
• Baptist Memorial Hospital

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1578527172
  Care Compare affiliation

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1518583129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 315",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209401",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7736 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715306",
            "telephone_number": "662-772-5222",
            "fax_number": "662-772-5957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Exeter Rd",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381383966",
            "country_code": "US",
            "telephone_number": "901-757-1350",
            "fax_number": "901-757-3496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "SUSAN",
        "middle_name": "ELYSE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "27393",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Southaven",
            "affiliation": "N",
            "address_1": "5932 Antler Trl",
            "city": "Southaven",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386726511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Madison McCaskill, CRNA
• Mariam McCauley
• Adrian Paul McClaren, LMFT
• Meredith Kelsey McCormick, PT
• Angela D. McCoy, CRNA
• Christopher Michael McDaniel, M.D.
• Henon Lee McDonald Jr., RN
• Jay Paul McDonald II, MD
• Tanya McFadden, PT
• Jessica McGarrity, DPT

• Family Nurse Practitioner in Southaven, MS
• Providers in Southaven, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.