MARY POLLEYS MCCULLOCH NNP
NPI 1275672396
Nurse Practitioner - Neonatal, Critical Care in Boise, ID
About Mary Polleys Mcculloch Nnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARY POLLEYS MCCULLOCH NNP (NPI 1275672396) is an individual neonatal, critical care provider in Boise, Idaho, licensed in Idaho (58268) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (1982).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Locations 2
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mary Polleys Mcculloch Nnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Mary Mcculloch reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Tremonton, UT 84337
- Reassigned Medicare billing, Utah enrollment
- 3,691 clinicians in this Medicare group
Tucson, AZ 85745
- Reassigned Medicare billing, Arizona enrollment
- 293 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 83712 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
BOISE, ID 83712
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mary Mcculloch's NPI number?
The NPI number for Mary Mcculloch is 1275672396. It was assigned to this individual provider in the NPPES registry on February 5, 2007.
Where is Mary Mcculloch located?
Mary Mcculloch practices at 190 E Bannock St, Boise, ID 83712. The listed phone number is (208) 381-2088.
What is Mary Mcculloch's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Neonatal, Critical Care, with taxonomy code 363LN0005X.
Is Mary Mcculloch enrolled in Medicare?
Yes. Mary Mcculloch is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Mary Mcculloch's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Mcculloch reassigns Medicare benefits to 2 organizations: Ihc Health Services Inc (Tremonton, UT) and Tucson Physician Group Holdings, LLC (Tucson, AZ). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Mcculloch's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mary Mcculloch accept?
Health plans from Blue Cross Blue Shield of Arizona and Providence Health Plan list Mary Mcculloch as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mary Mcculloch was last updated on April 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mary Polleys Mcculloch, NNP · NPI 1275672396
Neonatal, Critical Care physician in Boise, Idaho. Individual provider, active in the CMS NPPES registry since February 5, 2007.
## Identity
- **NPI:** 1275672396 (Entity type: Individual)
- **Enumerated:** February 5, 2007
- **Primary specialty:** Nurse Practitioner - Neonatal, Critical Care · taxonomy 363LN0005X
- **State license:** 58268 (Idaho)
- **Sole proprietor:** No
## Practice location
- **Address:** 190 E BANNOCK ST, Boise, ID 83712-6241
- **Phone:** (208) 381-2088
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Ihc Health Services Inc (NPI 1184082141, Tremonton, UT); Tucson Physician Group Holdings, LLC (NPI 1356726939, Tucson, AZ) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1982
## Record status
- **NPPES last updated:** April 27, 2026
- **Other identifiers:** Medicaid 176667 (AZ)
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Source: [NPI Profile](https://npiprofile.com/npi/1275672396) · Data from the CMS NPPES public registry.