NPIMap

Individual provider Active NPI

Ellen Cannon

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1083169890
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA058639 Issued in PA
Practice address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone
(610) 209-6383
NPI assigned
Aug 22, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA058639 PA
Physician Assistant 363A00000X MA058639 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Philadelphia, PA 19104-4319

Mailing address

1610 Christian St Apt 2
Philadelphia, PA 19146-2066

Other practice location 1

160 E Erie Ave
Philadelphia, PA 19134-1011
Phone (610) 209-6383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240404003755 CO Practitioner - Physician Assistant 5799145413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colorado Imaging Associates P CGroup PAC ID 6800880055, 61 clinicians
Colorado Advanced Endovascular, LLCGroup PAC ID 7416485008, 13 clinicians

Practice addresses (Care Compare)

11600 W 2ND PL
Lakewood, CO 80228-1527
Phone (303) 433-9729

11650 W 2ND PL
Lakewood, CO 80228-1527
Phone (303) 433-9729

14300 Orchard Pkwy
Westminster, CO 80023-9206
Phone (720) 627-3180

1950 Mountain View Ave
Longmont, CO 80501-3129
Phone (303) 651-5121

355 Union Blvd
Suite 100
Lakewood, CO 80228-1500
Phone (720) 669-3036

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.64 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA058639PAMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: coloradoadvancedendovascular.ellencannon@159105.advancedmd-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1083169890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 CHRISTIAN ST APT 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191462066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "610-209-6383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Erie Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191341011",
            "country_code": "US",
            "telephone_number": "610-209-6383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "ELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-22",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA058639",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.