Matthew McCullough, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

26NJ00222400 Issued in NJ

Practice address

285 Davidson Ave
Suite 204
Somerset, NJ 08873-4153

Phone

(732) 271-1400

Fax

(732) 271-3544

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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.

• Restoration and Wellness LLC

  • Adult Mental Health Clinic/Center
  • Fort Washington, PA
  • NPI 1770172033
  NPD Authorized official
• Ultracare Anesthesia Partners LLC

  • Anesthesiology Physician
  • Philadelphia, PA
  • NPI 1407236110
  Medicare reassignment
• Rancocas Anesthesiology, P.a.

  • Specialist
  • Mount Laurel, NJ
  • NPI 1427076553
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483747200000",
    "number": "1629135538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 DAVIDSON AVE",
            "address_2": "SUITE 204",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088734153",
            "telephone_number": "732-271-1400",
            "fax_number": "732-271-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 DAVIDSON AVE",
            "address_2": "SUITE 204",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088734153",
            "telephone_number": "732-271-1400",
            "fax_number": "732-271-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2017-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NJ002224000",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NJ00222400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anastatazja Maziarz, MD
• Marissa Mazur
• Liam McCabe, M.A., BCBA
• Richard McCann
• Daniel James McCarron, PTA
• Matthew McDonnell, MD
• Shaun McDonough, APN
• Ik McPaul
• Monica McVane, LPN
• Medical Associates of Central Jersey,PA

• Certified Registered Nurse Anesthetist in Somerset, NJ
• Providers in Somerset, NJ by specialty
• Certified Registered Nurse Anesthetist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.