Charles Larry Mccullouch Jr, MD - Medicare Family Medicine in Brooksville, MS

Charles Larry Mccullouch Jr, MD is a medicare enrolled "Family Medicine" physician in Brooksville, Mississippi. His current practice location is 1560 North Oliver St., Brooksville, Mississippi. You can reach out to his office (for appointments etc.) via phone at (662) 738-4424.

Charles Larry Mccullouch Jr is licensed to practice in Mississippi (license number 13953) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1710964754.

Contact Information

Charles Larry Mccullouch Jr, MD
1560 North Oliver St.,
Brooksville, MS 39739
(662) 738-4424
(662) 738-4615



Physician's Profile

Full NameCharles Larry Mccullouch Jr
GenderMale
SpecialityFamily Medicine
Location1560 North Oliver St., Brooksville, Mississippi
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1710964754
  • Provider Enumeration Date: 12/30/2005
  • Last Update Date: 06/19/2018
  Medicare PECOS Information:
  • PECOS PAC ID: 8729066923
  • Enrollment ID: I20040713001089

Medical Identifiers

Medical identifiers for Charles Larry Mccullouch Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1710964754NPI-NPPES
P00147884OtherRAILROAD MEDICARE
00125739MedicaidMS

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 13953 (Mississippi)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Charles Larry Mccullouch Jr allows following entities to bill medicare on his behalf.
Entity NameIndependent Healthcare Management Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1306909734
PECOS PAC ID: 0840197232
Enrollment ID: O20031215000487

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Entity NameCovington County Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1518260330
PECOS PAC ID: 4183517253
Enrollment ID: O20040203000816

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Entity NameSouth Sunflower County Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1184679292
PECOS PAC ID: 6709771637
Enrollment ID: O20040218000979

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Entity NamePioneer Health Services Of Monroe County, Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1083658595
PECOS PAC ID: 6305827478
Enrollment ID: O20040525001333

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Entity NameIndependent Healthcare Management Inc
Entity TypePart A Provider - Critical Access Hospital
Entity IdentifiersNPI Number: 1306909734
PECOS PAC ID: 0840197232
Enrollment ID: O20120111000488

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Entity NameBoa Vida Hospital Of Aberdeen Ms Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1710405741
PECOS PAC ID: 0244505840
Enrollment ID: O20171128003460

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Charles Larry Mccullouch Jr is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Charles Larry Mccullouch Jr, MD
1560 North Oliver St.,
Brooksville, MS 39739

Ph: (662) 738-4424
Charles Larry Mccullouch Jr, MD
1560 North Oliver St.,
Brooksville, MS 39739

Ph: (662) 738-4424

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Family Medicine Doctors in Brooksville, MS


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