NPIMap

Individual provider Active NPI

Shane Adam McCullough, PA-C

  • Physician Assistant
  • Billings, MT
National Provider Identifier
1891190658
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
59046 Issued in MT
Practice address
123 S 27TH St
Billings, MT 59101-4227
Phone
(406) 247-3350
Fax
(406) 247-3389
NPI assigned
Oct 22, 2014
Last updated
Jan 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 59046 MT Primary

Addresses

Primary practice location

123 S 27TH St
Billings, MT 59101-4227

Mailing address

123 S 27TH St
Billings, MT 59101-4227
Phone (406) 247-3350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20180103000421 MT Practitioner - Physician Assistant 3971826785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

123 S 27 St
Billings, MT 59101-4200

123 S 27TH St
Billings, MT 59101-4227
Phone (406) 247-3200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
59046MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Yellowstone City-County Health Department CurrentSince Nov 30, 2020 Accepting new patients
Ortho Montana, PSC CurrentSince Nov 19, 2017 Accepting new patients
Yellowstone City-County Health Dept CurrentSince Nov 30, 2020 Accepting new patients
Yellowstone City-County Health Department Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

123 S 27th St
Billings, MT 59101
Phone (406) 247-3200

1739 Spring Creek Rd
Billings, MT 59102
Phone (406) 237-5050

2900 12th Ave N
Ste 140W
Billings, MT 59101
Phone (406) 237-5050

Interoperability endpoints

  • Direct secure messaging: shane.mccullough@1146.chartlogic.direct-ci.com

Organizations & group practices 5

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 10

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": "1413936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1891190658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 S 27TH ST",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591014227",
            "telephone_number": "406-247-3350",
            "fax_number": "406-247-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S 27TH ST",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591014227",
            "telephone_number": "406-247-3350",
            "fax_number": "406-247-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "SHANE",
        "middle_name": "ADAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-22",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "59046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Billings, MT

Sources for this page

Verify at the official NPI Registry.