Michael Reid McCullough, DO

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

License

H9682 Issued in TX

Practice address

643 S Great Southwest Pkwy
Suite 101
Grand Prairie, TX 75051-1056

Phone

(972) 988-1588

Fax

(972) 602-0615

NPI assigned

Jun 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in TX

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

Flagged The directory lists this NPI on an HHS exclusion list. 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 Osteopathy, Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: michael.mccullough.1@19934.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 and National Provider Directory roles.

• Pediatrix Medical Group of Texas Billing, Inc.

  • Neonatal-Perinatal Medicine Physician
  • Houston, TX
  • NPI 1649377359

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1932135704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 S GREAT SOUTHWEST PKWY",
            "address_2": "SUITE 101",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511056",
            "telephone_number": "972-988-1588",
            "fax_number": "972-602-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 S GREAT SOUTHWEST PKWY",
            "address_2": "SUITE 101",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511056",
            "telephone_number": "972-988-1588",
            "fax_number": "972-602-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "MICHAEL",
        "middle_name": "REID",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "TX",
            "license": "H9682",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "H9682",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033519201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP ID",
            "identifier": "10028878",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275832362",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA  ID",
            "identifier": "4250747",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "G74V",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TPI",
            "identifier": "033519201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayne A McAnalley, M.D.
• Johnny McCall, BCPC, LCDC, LPC-A
• Shanika Latrice McClain
• Jasmine McCoy
• Jason Daniel McCoy, LMT, SLT
• MCD Medical Devices and Supplies LLC
• Bunnoi A McDaniel, LPC
• Brian McDonough, APRN-CNP
• Kaffie McDowell, RNC-WHNP
• Erin McGee, LPC, CSC, NCC

• Obstetrics Physician in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Obstetrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.