PAMELA R MCCULLOCH (MD) – Anesthesiology Physician, NPI 1124018668
Anesthesiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for PAMELA R MCCULLOCH (MD)
5734, Coventry Lane, Liberty Hills, Fort Wayne, Allen County, Indiana, 46804, United States
FORT WAYNE, IN 468047141
Phone: (260) 436-7875
Type: Location
PO BOX 633260
CINCINNATI, OH 452633260
Phone: (317) 802-6303
Fax: (317) 870-0499
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-10-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20101015000414 | I | Anesthesiology | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 00145 | Anesthesia for retinal surgery | 11 | 11 | $0 |
Insurance plans in this area (ZIP 46804)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| ANESTHESIOLOGY | IN | 00142 | Anesthesia for lens surgery | 13 | 13 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | MI | |
| - | IN | |
| A N E S T H E S I O L O G Y | IN | |
| - | OH | |
| Certified Registered Nurse Anesthetist (Crna) | IN | |
| Certified Registered Nurse Anesthetist (Crna) | TX | |
| Certified Registered Nurse Anesthetist (Crna) | IN | |
| - | OH | |
| Certified Registered Nurse Anesthetist (Crna) | TN | |
| Certified Registered Nurse Anesthetist (Crna) | IN |
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