Active NPI
Peggy Lisa McCullum, CNM
- Midwife
- Corvallis, OR
National Provider Identifier
1528005253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- 200450148NP
- Practice address
- 3640 NW Samaritan Dr Ste 220
Corvallis, OR 97330-3784 - Phone
- (541) 768-5300
- NPI assigned
- Jun 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | 200450148NP | OR | |
| Midwife | 176B00000X | 200450148NP | OR | Primary |
Addresses
Primary practice location
3640 NW Samaritan Dr Ste 220
Corvallis, OR 97330-3784
Mailing address
PO Box 1189
Corvallis, OR 97339-1189
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200450148NP | Other | OR | STATE LICENSE |
| 200442216RN | Other | OR | STATE LICENSE |
| 269512 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pmccullum129969@samhealth.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200450148NP | OR | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1528005253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1189",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973391189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3640 NW SAMARITAN DR STE 220",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973303784",
"telephone_number": "541-768-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLUM",
"first_name": "PEGGY",
"middle_name": "LISA",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-01",
"last_updated": "2020-11-10",
"certification_date": "2020-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "OR",
"license": "200450148NP",
"primary": false
},
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "OR",
"license": "200450148NP",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "200450148NP",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "200442216RN",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "269512",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pmccullum129969@samhealth.direct-ci.com",
"affiliation": "N",
"address_1": "3640 NW Samaritan Dr Ste 220",
"city": "Corvallis",
"state": "OR",
"country_code": "US",
"postal_code": "973303784",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.