NPIMap

Individual provider Active NPI

Angela B. McCallum, FNP

  • Family Nurse Practitioner
  • Magee, MS
National Provider Identifier
1659755676
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R856059 Issued in MS
Practice address
360 Simpson Highway 149 Ste 370
Magee, MS 39111-3843
Phone
(601) 849-1530
Fax
(601) 849-1535
NPI assigned
Jul 20, 2015
Last updated
Apr 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R856059 MS Primary

Addresses

Primary practice location

360 Simpson Highway 149 Ste 370
Magee, MS 39111-3843

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 849-1530

Other practice location 1

969 Lakeland Dr
Jackson, MS 39216-4606
Phone (601) 200-4644

Other identifiers 2

IdentifierTypeStateIssuer
07780038MedicaidMS
431343AB6FOtherMSMEDICARE ST DOM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150828001492 MS Practitioner - Nurse Practitioner 4789990284 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mississippi Medical Clinic of MendehallGroup PAC ID 0345782637, 2 clinicians

Practice addresses (Care Compare)

2170 Simpson Hwy 49
Mendenhall, MS 39114-5418
Phone (601) 675-1200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R856059MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mississippi Medical Clinic of Mendehall CurrentSince Mar 13, 2024 Accepting new patients
Mississippi Medical Clinic Family CurrentSince Jul 15, 2023 Accepting new patients
Covington County Hospital Current Accepting new patients
Thomas R. Blackledge, Jr., MD, PA Current Accepting new patients
Covington County Hospital CurrentSince Sep 1, 2021 Accepting new patients

Locations

800 3rd St SW
Magee, MS 39111
Phone (601) 849-1918

403 Pine St
Taylorsville, MS 39168
Phone (601) 452-7080

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1659755676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-849-1530",
            "fax_number": "601-849-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SIMPSON HIGHWAY 149 STE 370",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113843",
            "telephone_number": "601-849-1530",
            "fax_number": "601-849-1535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "969 Lakeland Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164606",
            "country_code": "US",
            "telephone_number": "601-200-4644",
            "fax_number": "601-200-4645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCALLUM",
        "first_name": "ANGELA",
        "middle_name": "B.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R856059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07780038",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ST DOM",
            "identifier": "431343AB6F",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Magee, MS

Sources for this page

Verify at the official NPI Registry.