NPIMap

Individual provider Active NPI

Daniel McCullough

  • Physician Assistant
  • Montclair, CA
National Provider Identifier
1992259071
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
53829 Issued in CA
Practice address
8891 Central Ave
Suite a
Montclair, CA 91763-1618
Phone
(909) 297-3361
NPI assigned
Aug 7, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8672 AZ
Physician Assistant 363A00000X 53829 CA Primary

Addresses

Primary practice location

8891 Central Ave
Suite a
Montclair, CA 91763-1618

Mailing address

8891 Central Ave
Suite a
Montclair, CA 91763-1618

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170127002328 CA Practitioner - Physician Assistant 4880976703 Reassigns benefits to 4 organizations
I20211213002621 AZ Practitioner - Physician Assistant 4880976703 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tec Emergency Physicians of Arizona, LLCGroup PAC ID 6204256084, 155 clinicians

Practice addresses (Care Compare)

7171 S 51St Ave
Laveen, AZ 85339-2923
Phone (888) 732-3317

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53829CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Honorhealth Ambulatory CurrentSince Jan 3, 2022 Accepting new patients
Honorhealth Ambulatory CurrentSince Jan 3, 2022 Accepting new patients

Locations

10510 N 92nd St
Ste 200
Scottsdale, AZ 85258
Phone (480) 323-1250

10101 N 92nd St
Ste 101
Scottsdale, AZ 85258
Phone (480) 860-1919

7400 E Osborn Rd
Scottsdale, AZ 85251
Phone (480) 481-4000

7351 E Osborn Rd
Ste 200B
Scottsdale, AZ 85251
Phone (480) 882-5730

Interoperability endpoints

  • Direct secure messaging: daniel.mccullough.1@19960.direct.athenahealth.com

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1470528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1992259071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8891 CENTRAL AVE",
            "address_2": "SUITE A",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8891 CENTRAL AVE",
            "address_2": "SUITE A",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631618",
            "telephone_number": "909-297-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-07",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8672",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

Verify at the official NPI Registry.