Kelly D McCullough, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD00040121 Issued in WA

Practice address

2979 Squalicum Pkwy
Suite 301
Bellingham, WA 98225-1811

Phone

(360) 734-1420

Fax

(360) 756-6666

NPI assigned

Apr 25, 2006

Last updated

Feb 24, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

GastroenterologyAlso: Internal Medicine

Education

University of Washington School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northwest Gastroenterology Professional LLCGroup PAC ID 9335052265, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St Joseph Medical Center Hospital, Bellingham, WA, CCN 500030
• Peacehealth United General Medical Center Hospital, Sedro Woolley, WA, CCN 501329

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Northwest Gastroenterology Professional LLC

  • Gastroenterology Physician
  • Bellingham, WA
  • NPI 1033278411
  Medicare reassignment Care Compare group NPD

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

• Peacehealth

  dba PeaceHealth United General Medical Center

  • Critical Access Hospital
  • Sedro Woolley, WA
  • NPI 1144664954
  Care Compare affiliation
• Peacehealth

  dba St. Joseph Medical Center

  • Rural Acute Care Hospital
  • Bellingham, WA
  • NPI 1487904546
  Care Compare affiliation
• Peacehealth

  dba St Joseph Medical Center

  • General Acute Care Hospital
  • Bellingham, WA
  • NPI 1689677320
  Care Compare affiliation
• St Joseph Hospital

  dba Northwest Regional Laboratory

  • Clinical Medical Laboratory
  • Bellingham, WA
  • NPI 1013137173

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235433600000",
    "number": "1841256260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2979 SQUALICUM PKWY",
            "address_2": "SUITE 301",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251811",
            "telephone_number": "360-734-1420",
            "fax_number": "360-756-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2979 SQUALICUM PKWY",
            "address_2": "SUITE 301",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251811",
            "telephone_number": "360-734-1420",
            "fax_number": "360-756-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "KELLY",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2009-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD00040121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8426272",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alex J McCormick
• Whitney Rydingsvard McCormick
• Kaaran McCrea, RN
• Melissa McCreery, PH.D.
• Fairleth Patricia McCuaig, ARNP
• Amanda McDade, LMHC
• Patricia E McDermott, PTA
• Daniel McDonald
• Kelly Marie McDonald, BA
• Stephanie Ellen McDonald, MA, LMHC

• Gastroenterology Physician in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Gastroenterology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.