Individual provider Active NPI

Matthew Alan McCullough, M.D.

  • Internal Medicine Physician
  • Valencia, CA
National Provider Identifier
1679839732
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A128263 Issued in CA
Practice address
27235 Tourney Rd Ste 2500
Valencia, CA 91355-5908
Phone
(661) 253-5851
Fax
(661) 535-5852
NPI assigned
Apr 3, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A128263 CA Primary

Addresses

Primary practice location

27235 Tourney Rd Ste 2500
Valencia, CA 91355-5908

Mailing address

5767 W Century Blvd Suite 400
Los Angeles, CA 90095-5631
Phone (310) 301-8707

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150923001850 CA Practitioner - Internal Medicine 0648587683 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A128263CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Jul 1, 2015 Accepting new patients
County of Los Angeles CurrentSince Jul 1, 2015 Accepting new patients

Locations

14445 Olive View Dr
#2C155
Sylmar, CA 91342
Phone (818) 364-3001

14445 Olive View Dr
#2B182
Sylmar, CA 91342
Phone (747) 210-3205

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Interoperability endpoints

  • Direct secure messaging: mmccullough43102@direct.uclahealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1679839732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900955631",
            "telephone_number": "310-301-8707",
            "fax_number": "310-301-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27235 TOURNEY RD STE 2500",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555908",
            "telephone_number": "661-253-5851",
            "fax_number": "661-535-5852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MATTHEW",
        "middle_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-03",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A128263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

Verify at the official NPI Registry.