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SAMUEL SCOTT MCCULLOUGH III FNP-C
NPI 1750923538
Nurse Practitioner in Gluckstadt, MS

Active since October 12, 2019PECOS Enrolled
102 HAZELTON CV, GLUCKSTADT, MS 39110(601) 633-9017 Get Directions Write a Review

NPPES record last updated: March 15, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Mar 15, 2026, Oct 12, 2019 (2 updates tracked since 2019).

About Samuel Scott Mccullough Iii Fnp-c NPPES

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

SAMUEL SCOTT MCCULLOUGH III FNP-C (NPI 1750923538) is an individual nurse practitioner in Gluckstadt, Mississippi, licensed in Mississippi (903614) and active in the NPI registry since October 2019. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1750923538
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameSAMUEL SCOTT MCCULLOUGH IIICredential: FNP-C
Location Address102 HAZELTON CVGluckstadt, MS 39110-6961
Mailing Address106 Eagle CvMadison, MS 39110-6629 · (601) 260-9830
Phone(601) 633-9017
Sole ProprietorYes
Enumeration DateOctober 12, 2019
Last NPPES UpdateMarch 15, 20262 updates tracked since enumeration
NPPES CertifiedMarch 15, 2026
✔ NPI 1750923538 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in MS · 903614
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
102 HAZELTON CV, Gluckstadt, MS 39110
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Scott Mccullough Iii Fnp-c 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39110 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 Samuel Mccullough's NPI number?

The NPI number for Samuel Mccullough is 1750923538. It was assigned to this individual provider in the NPPES registry on October 12, 2019.

Where is Samuel Mccullough located?

Samuel Mccullough practices at 102 Hazelton Cv, Gluckstadt, MS 39110. The listed phone number is (601) 633-9017.

What is Samuel Mccullough's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Samuel Mccullough enrolled in Medicare?

Yes. Samuel Mccullough is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samuel Mccullough was last updated on March 15, 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.