Charles Larry McCullouch Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

13953 Issued in MS

Practice address

1560 North Oliver St.
Brooksville, MS 39739

Phone

(662) 738-4424

Fax

(662) 738-4615

NPI assigned

Dec 30, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/covingc-3983785e
• Direct secure messaging: charles.mccullouch.1@15070.direct.athenahealth.com

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.

• Boa Vida Hospital of Aberdeen, Ms, LLC

  dba Monroe Regional Hospital

  • Multi-Specialty Clinic/Center
  • Aberdeen, MS
  • NPI 1710405741
  Medicare reassignment NPD
• Covington County Hospital

  dba Family Care of Main Street

  • Rural Health Clinic/Center
  • Collins, MS
  • NPI 1518260330
  Medicare reassignment NPD
• Independent Healthcare Management, Inc.

  dba S E Lackey Memorial Hospital

  • Critical Access Hospital
  • Forest, MS
  • NPI 1306909734
  Medicare reassignment NPD
• South Sunflower County Hospital

  • General Acute Care Hospital
  • Indianola, MS
  • NPI 1184679292
  Medicare reassignment NPD
• WMC Emergency Services LLC

  • General Acute Care Hospital
  • Louisville, MS
  • NPI 1336786235
  Medicare reassignment NPD
• Boa Vida Hospital of Aberdeen, Ms LLC

  dba MRH Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Aberdeen, MS
  • NPI 1134858269
  NPD
• Covington County Hospital

  dba Smith County EH Pro Fees

  • Emergency Medical Services (Emergency Medicine) Physician
  • Raleigh, MS
  • NPI 1003654567
  NPD
• Covington County Hospital

  dba Family Care Express

  • Rural Health Clinic/Center
  • Collins, MS
  • NPI 1013205350
  NPD
• Independent Healthcare Management, Inc,

  dba S. E. Lackey Memorial Hospital

  • Critical Access Hospital
  • Forest, MS
  • NPI 1649592791
  NPD
• Independent Healthcare Management, Inc.

  dba 35 South Family Medical

  • Rural Health Clinic/Center
  • Raleigh, MS
  • NPI 1871272724
  NPD
• South Sunflower County Hospital

  • Family Nurse Practitioner
  • Indianola, MS
  • NPI 1336706803
  NPD
• South Sunflower County Hospital

  • Anesthesiology Physician
  • Indianola, MS
  • NPI 1407064454
  NPD

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1710964754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 NORTH OLIVER ST.",
            "city": "BROOKSVILLE",
            "state": "MS",
            "postal_code": "39739",
            "telephone_number": "662-738-4424",
            "fax_number": "662-738-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 NORTH OLIVER ST.",
            "city": "BROOKSVILLE",
            "state": "MS",
            "postal_code": "39739",
            "telephone_number": "662-738-4424",
            "fax_number": "662-738-4615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "562 E Main St",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "MS",
            "postal_code": "393392742",
            "country_code": "US",
            "telephone_number": "662-779-5150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUCH",
        "first_name": "CHARLES",
        "middle_name": "LARRY",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-30",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "13953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00147884",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125739",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Ashley Hammons, MS CCC SLP
• Karla Jernigan, FNP
• Rachel Marie Lafferty, PT
• Macon City Drug Store, Inc. (Brooksville Drug Store)
• John C Mason, PHARM/D
• Noxubee General Critical Access Hospital (Brooksville Medical Clinic)
• Noxubee General Critical Access Hospital (Brooksville Pharmacy)
• Holly C Rigdon, NP
• Katelyn Ryan
• Kim Willams Truesdale, CRNP

• Family Medicine Physician in Brooksville, MS
• Providers in Brooksville, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.