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CHARLES LARRY MCCULLOUCH JR. MD
NPI 1710964754
Family Medicine in Brooksville, MS

Active since December 30, 2005PECOS Enrolled
1560 NORTH OLIVER ST., BROOKSVILLE, MS 39739(662) 738-4424(662) 738-4615 Get Directions Write a Review

NPPES record last updated: June 19, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Charles Larry Mccullouch Jr. Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLES LARRY MCCULLOUCH JR. MD (NPI 1710964754) is an individual family medicine provider in Brooksville, Mississippi, licensed in Mississippi (13953) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS and maintains a secondary practice location in Louisville.

NPPES Registry Identity

NPI1710964754
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameCHARLES LARRY MCCULLOUCH JR.Credential: MD
Location Address1560 NORTH OLIVER ST.Brooksville, MS 39739
Mailing Address1560 North Oliver St.Brooksville, MS 39739 · (662) 738-4424 · Fax (662) 738-4615
Phone(662) 738-4424
Fax(662) 738-4615
Sole ProprietorYes
Enumeration DateDecember 30, 2005
Last NPPES UpdateJune 19, 2018
✔ NPI 1710964754 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in MS · 13953
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1560 NORTH OLIVER ST., Brooksville, MS 39739
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Secondary Practice Location 1

Location 1562 E Main StLouisville, MS 39339-2742 · Phone (662) 779-5150

Other Identifiers 2

Medicaid00125739MS
OtherP00147884Railroad Medicare

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Charles Larry Mccullouch Jr. Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

5

Medicare enrollment records show Charles Mccullouch reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Wmc Emergency Services LLC
29 mi
General Acute Care Hospital
17550 E MAIN ST
Louisville, MS 39339
  • Reassigned Medicare billing, Mississippi enrollment
  • 21 clinicians in this Medicare group
NPI 1336786235 (662) 773-6211
Boa Vida Hospital Of Aberdeen, Ms LLC
40 mi
Clinic/Center
502 S CHESTNUT ST
Aberdeen, MS 39730
  • Reassigned Medicare billing, Mississippi enrollment
  • 168 clinicians in this Medicare group
NPI 1467115279 (662) 319-8844
Independent Healthcare Management, Inc.
63 mi
Rural Health
17509 HWY 21
Sebastopol, MS 39359
  • Reassigned Medicare billing, Mississippi enrollment
  • Also billed through NPI 1306909734 (Mississippi)
  • 94 clinicians in this Medicare group
NPI 1760778609 (601) 625-9818
South Sunflower County Hospital
121 mi
Rural Health
122 E BAKER ST
Indianola, MS 38751
  • Reassigned Medicare billing, Mississippi enrollment
  • 89 clinicians in this Medicare group
NPI 1245248699 (662) 887-2212
Covington County Hospital
124 mi
Rural Health
701 S HOLLY AVE
Collins, MS 39428
  • Reassigned Medicare billing, Mississippi enrollment
  • 69 clinicians in this Medicare group
NPI 1518260330 (601) 765-2746

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with low level of medical decision making 99283
An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
76 services65 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
21 services21 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39739 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$80.50 typical visit price
range $51.65 – $159.18
Typical copayment $20.12 (range $12.91 – $39.79)
Most-billed visit code 99203
Established Patient
$92.20 typical visit price
range $16.15 – $129.61
Typical copayment $23.05 (range $4.03 – $32.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Charles Mccullouch's NPI number?

The NPI number for Charles Mccullouch is 1710964754. It was assigned to this individual provider in the NPPES registry on December 30, 2005.

Where is Charles Mccullouch located?

Charles Mccullouch practices at 1560 North Oliver St., Brooksville, MS 39739. The listed phone number is (662) 738-4424.

What is Charles Mccullouch's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Charles Mccullouch enrolled in Medicare?

Yes. Charles Mccullouch is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Charles Mccullouch's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Charles Mccullouch reassigns Medicare benefits to 5 organizations: Wmc Emergency Services LLC (Louisville, MS), Boa Vida Hospital Of Aberdeen, Ms LLC (Aberdeen, MS), Independent Healthcare Management, Inc. (Sebastopol, MS), South Sunflower County Hospital (Indianola, MS) and Covington County Hospital (Collins, MS). 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 Charles Mccullouch's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Charles Mccullouch was last updated on June 19, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years 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.