Lamonice Marie Mccullom, NP is a medicare enrolled "Nurse Practitioner" in Waveland, Mississippi. Her current practice location is
451 Highway 90, Waveland, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(228) 400-0055.
Lamonice Marie Mccullom is licensed to practice in Mississippi (license number 907308) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1760284483.
Provider's Profile
| Full Name | Lamonice Marie Mccullom |
|---|
| Gender | Female |
|---|
| Speciality | Nurse Practitioner |
|---|
| Location | 451 Highway 90, Waveland, Mississippi |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1760284483
- Provider Enumeration Date: 03/25/2025
- Last Update Date: 03/25/2025
Medicare PECOS Information:
- PECOS PAC ID: 7517477995
- Enrollment ID: I20250605003975
Medical Identifiers
Medical identifiers for Lamonice Marie Mccullom such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1760284483 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363L00000X | Nurse Practitioner | 907308 (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. Lamonice Marie Mccullom allows following entities to bill medicare on her behalf.
| Entity Name | Fast Pace Mississippi Pllc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1447769559
PECOS PAC ID: 3678832029
Enrollment ID: O20180111000291 |
|---|
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. Lamonice Marie Mccullom 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 Address | Practice Location Address |
|---|
Lamonice Marie Mccullom, NP
10580 Steeplechase Dr,
Gulfport, MS 39503-4279
Ph: (228) 224-7953 | Lamonice Marie Mccullom, NP
451 Highway 90,
Waveland, MS 39576-2507
Ph: (228) 400-0055 |
Reviews and Comments