Samuel Scott Mccullough Iii, FNP-C in Gluckstadt, MS

Samuel Scott Mccullough Iii, FNP-C is a medicare enrolled "Nurse Practitioner" in Gluckstadt, Mississippi. His current practice location is 102 Hazelton Cv, Gluckstadt, Mississippi. You can reach out to his office (for appointments etc.) via phone at (601) 633-9017.

Samuel Scott Mccullough Iii is licensed to practice in Mississippi (license number 903614) 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 1750923538.

Contact Information

	Samuel Scott Mccullough Iii, FNP-C
	102 Hazelton Cv, Gluckstadt, MS 39110-6961
	(601) 633-9017
	Not Available

Map and Direction

Provider's Profile

Full Name	Samuel Scott Mccullough Iii
Gender	Male
Speciality	Nurse Practitioner
Location	102 Hazelton Cv, Gluckstadt, Mississippi
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1750923538
Provider Enumeration Date: 10/12/2019
Last Update Date: 03/15/2026

Medicare PECOS Information:

PECOS PAC ID: 2961844519
Enrollment ID: I20240528002401

Medical Identifiers

Medical identifiers for Samuel Scott Mccullough Iii such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1750923538	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	903614 (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. Samuel Scott Mccullough Iii allows following entities to bill medicare on his behalf.

Entity Name	Synergy Wound Care Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1225883184 PECOS PAC ID: 2163864711 Enrollment ID: O20240528002306

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. Samuel Scott Mccullough Iii 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
Samuel Scott Mccullough Iii, FNP-C 106 Eagle Cv, Madison, MS 39110-6629 Ph: (601) 260-9830	Samuel Scott Mccullough Iii, FNP-C 102 Hazelton Cv, Gluckstadt, MS 39110-6961 Ph: (601) 633-9017

Reviews and Comments

Nurse Practitioner Nurses in Gluckstadt, MS

Laura K Tanksley, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1040 Gluckstadt Rd Ste B, Gluckstadt, MS 39110 Phone: 601-605-0452
Clarence D Hayes, PMHNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 113 First Colony Blvd, Gluckstadt, MS 39110 Phone: 601-807-1624
Avery Nash, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 101 Lexington Dr Ste A, Gluckstadt, MS 39110 Phone: 601-707-3771 Fax: 601-707-3751
Allison H Smith, FNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 148 Weisenberger Rd Ste C, Gluckstadt, MS 39110 Phone: 601-607-9582 Fax: 570-203-7117

Samuel Scott Mccullough Iii, FNP-C - Medicare Nurse Practitioner in Gluckstadt, MS