Gabrielle Maccallum, PA-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PT2021-73 Issued in AR

Practice address

600 S Timberlane Dr
El Dorado, AR 71730-6990

Phone

(870) 862-2400

NPI assigned

Apr 24, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Sama Healthcare Services, PA

  • Primary Care Clinic/Center
  • El Dorado, AR
  • NPI 1235290735
  Medicare reassignment
• Trevecca Nazarene University

  • Local Education Agency (LEA)
  • Nashville, TN
  • NPI 1033407952
  NPD (past)

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

{
    "created_epoch": "1619222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1811579386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S TIMBERLANE DR",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717306990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S TIMBERLANE DR",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717306990",
            "telephone_number": "870-862-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACCALLUM",
        "first_name": "GABRIELLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "PT2021-73",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ross Lowery
• Allyn Elizabeth Lowry, M.A., CCC-SLP
• Christopher Paul Lowry, M.A., CCC-A (AUDIOLO
• Linda Garrett Lowry, ACA
• Tiffany Dawn Lucas, APRN, AGPCNP-BC
• Jessica H Mack, DNP, APRN, AGACNP-BC
• Monica Lynn Mack, PHARMD
• Levi Nathaniel Maggard, CRNA
• Wendi Makus
• Crystle Syon'Tze Malone, MS, PBSS

• Family Medicine Physician in El Dorado, AR
• Providers in El Dorado, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.