NPIMap

Organization Active NPI

Charles a. Cannon, Jr. Memorial Hospital, Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Linville, NC
National Provider Identifier
1215098132
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
Legal business name
CHARLES A. CANNON, JR. MEMORIAL HOSPITAL, INC
Practice address
434 Hospital Drive
Linville, NC 28646-0787
Phone
(828) 262-9154
Fax
(828) 262-9159
NPI assigned
Dec 13, 2006
Last updated
Jan 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

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

Authorized official

Name
Mrs. Mary Etta Long, RHIA-CPMSM
Title
Sr VP Medical Staff Services
Phone
(828) 262-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207PE0004X Primary

Addresses

Primary practice location

434 Hospital Drive
Linville, NC 28646-0787

Mailing address

PO Box 787
Linville, NC 28646-0787
Phone (828) 262-9154

Other identifiers 3

IdentifierTypeStateIssuer
8907744MedicaidNC
019MGOtherBLUE CROSS OF NC
0094980OtherNCBLUECARE

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000998 NC Part B Supplier - Clinic/Group Practice 3274426952 Receives reassigned benefits from 29 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Linville, NC

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1215098132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 787",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460787",
            "telephone_number": "828-262-9154",
            "fax_number": "828-262-9159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 HOSPITAL DRIVE",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460787",
            "telephone_number": "828-262-9154",
            "fax_number": "828-262-9159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A. CANNON, JR. MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ETTA",
        "authorized_official_title_or_position": "SR VP MEDICAL STAFF SERVICES",
        "authorized_official_telephone_number": "828-262-4133",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RHIA-CPMSM"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8907744",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF NC",
            "identifier": "019MG",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE",
            "identifier": "0094980",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Linville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.