NPIMap

Individual provider Active NPI

Stephen R Cannon, MD

  • Family Medicine Physician
  • Crowley, LA
National Provider Identifier
1083777908
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
025690 Issued in LA
Practice address
1325 Wright Ave Ste a
Crowley, LA 70526-2226
Phone
(337) 783-4043
Fax
(337) 783-4053
NPI assigned
Dec 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 025690 LA Primary

Addresses

Primary practice location

1325 Wright Ave Ste a
Crowley, LA 70526-2226

Mailing address

1325 Wright Ave Ste a
Crowley, LA 70526-2226
Phone (337) 783-4043

Other identifiers 2

IdentifierTypeStateIssuer
1048577MedicaidLA
2372793MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stephen-r-cannon@crowleyprimary.e-mdsdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20041006000741 LA Practitioner - Family PracticePractitioner - Emergency Medicine 3577522424 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Louisiana State University School of Medicine in Shreveport, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crowley Primary Care, LLCGroup PAC ID 8527289974, 5 clinicians

Practice addresses (Care Compare)

1325 Wright Ave
Suite a
Crowley, LA 70526-2226
Phone (337) 783-4043

Hospital & facility affiliations

  • Lamm Family Care Home Health Home health agency, Crowley, LA, CCN 197274
  • Acadian Homecare, LLC Home health agency, Lafayette, LA, CCN 197060
  • Acadia General Hospital Hospital, Crowley, LA, CCN 190044
  • Ochsner Lafayette General Medical Center Hospital, Lafayette, LA, CCN 190002
  • Abrom Kaplan Memorial Hospital Hospital, Kaplan, LA, CCN 191322
  • Ochsner American Legion Hospital Hospital, Jennings, LA, CCN 190053
  • Louisiana Extended Care Hospital of Lafayette Long-term care hospital, Lafayette, LA, CCN 192032
  • Southwind Nursing & Rehabilitation Center Nursing home, Crowley, LA, CCN 195563

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
025690LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hub City Physician Group, LLC CurrentSince Jan 16, 2021 Accepting new patients
Crowley Primary Care, LLC Family Medicine CurrentSince Aug 1, 2014 Accepting new patients
Nancy Briley Walker, M.D., a.P.M. L.L.C. Family Medicine Current Accepting new patients
Bioactive Infusion & Wellness of Baton Rouge, LLC CurrentSince Sep 17, 2023 Accepting new patients

Locations

1305 E Highway 90
Crowley, LA 70526
Phone (337) 783-3222

1325 Wright Ave
Ste A
Crowley, LA 70526
Phone (337) 783-4043

3501 Highway 190
Eunice, LA 70535
Phone (337) 580-7500

1310 W 7th St
Kaplan, LA 70548
Phone (318) 643-8300

100 W Louisiana Ave
Rayne, LA 70578
Phone (337) 581-7009

Interoperability endpoints

  • Direct secure messaging: stephen-r-cannon@crowleyprimary.e-mdsdirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Crowley Primary Care, LLCCrowley, LA, CCN 198914 Rural health clinic Operational/Managerial Control Apr 24, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 10

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1083777908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 WRIGHT AVE STE A",
            "city": "CROWLEY",
            "state": "LA",
            "postal_code": "705262226",
            "telephone_number": "337-783-4043",
            "fax_number": "337-783-4053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 WRIGHT AVE STE A",
            "city": "CROWLEY",
            "state": "LA",
            "postal_code": "705262226",
            "telephone_number": "337-783-4043",
            "fax_number": "337-783-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "STEPHEN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "025690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1048577",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2372793",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stephen-r-cannon@crowleyprimary.e-mdsdirect.com",
            "affiliation": "N",
            "endpointDescription": "stephen-r-cannon@crowleyprimary.e-mdsdirect.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "stephen-r-cannon@crowleyprimary.e-mdsdirect.com",
            "address_1": "1325 Wright Ave Ste A",
            "city": "Crowley",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705262226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crowley, LA

Sources for this page

Verify at the official NPI Registry.