Individual provider Active NPI

Shay Cannon, PA

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1124757513
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9116245 Issued in FL
Practice address
2 Tampa General Cir
Tampa, FL 33606-3571
Phone
(813) 821-8724
NPI assigned
Jun 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 9116245 FL
Physician Assistant 363A00000X PA9116245 FL Primary

Addresses

Primary practice location

2 Tampa General Cir
Tampa, FL 33606-3571

Mailing address

PO Box 917770
Orlando, FL 32891-0001

Other identifiers 1

IdentifierTypeStateIssuer
U49E2OtherFLBCBS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address scannon249941@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221103002322 FL Practitioner - Physician Assistant 1759758741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Florida College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Medical Service Association IncGroup PAC ID 6800790221, 818 clinicians

Practice addresses (Care Compare)

4202 E Fowler Ave
Tampa, FL 33620-6750

Hospital & facility affiliations

  • Tampa General Hospital Hospital, Tampa, FL, CCN 100128

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9116245FLMDPlastic Surgery Physician
PA9116245FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Service Association Inc CurrentSince Sep 28, 2022 Accepting new patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc CurrentSince Sep 28, 2022 Accepting new patients
University Medical Service Association Inc Physician Assistant Past Accepting new patients

Locations

2 Tampa General Cir
Tampa, FL 33606
Phone (813) 259-8700

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

12901 Bruce B Downs Blvd
#19
Tampa, FL 33612
Phone (813) 844-4103

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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 1

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": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1124757513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 TAMPA GENERAL CIR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336063571",
            "telephone_number": "813-821-8724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "SHAY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "FL",
            "license": "9116245",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "U49E2",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scannon249941@direct.tgh.org",
            "affiliation": "N",
            "address_1": "2 Tampa General Cir",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336063571",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.