Active NPI
Debra C Cannon, PA-C
- Medical Physician Assistant
- Dayton, OH
National Provider Identifier
1215041876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 50-001982
- Practice address
- 4100 W 3Rd St
Dayton, OH 45428-9000 - Phone
- (937) 268-6511
- Fax
- (937) 267-5316
- NPI assigned
- Aug 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 50-001982 | OH | Primary |
Addresses
Primary practice location
4100 W 3Rd St
Dayton, OH 45428-9000
Mailing address
6889 Evergreen Cir
Huber Heights, OH 45424-3992
Phone (937) 235-2658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50-001982 | OH | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Samaritan Emergency Corp | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
- Emergency Medicine Physician
- Dayton, OH
- NPI 1922084136
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215041876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6889 EVERGREEN CIR",
"city": "HUBER HEIGHTS",
"state": "OH",
"postal_code": "454243992",
"telephone_number": "937-235-2658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 W 3RD ST",
"city": "DAYTON",
"state": "OH",
"postal_code": "454289000",
"telephone_number": "937-268-6511",
"fax_number": "937-267-5316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "DEBRA",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OH",
"license": "50-001982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.