Individual provider Active NPI

Nathan Allen Cannon, M.D./PH.D.

  • Radiation Oncology Physician
  • Fort Wayne, IN
National Provider Identifier
1225343072
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
01075113A Issued in IN
Practice address
11050 Parkview Circle Dr
Fort Wayne, IN 46845
Phone
(260) 266-9100
NPI assigned
Aug 17, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 01075113A IN Primary

Addresses

Primary practice location

11050 Parkview Circle Dr
Fort Wayne, IN 46845

Mailing address

7910 W Jefferson Blvd Ste 110
Fort Wayne, IN 46804-4159
Phone (260) 436-4116

Other identifiers 2

IdentifierTypeStateIssuer
201292540MedicaidIN
0134869MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150619000974 IN Practitioner - Radiation Oncology 0648581405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Saint Louis University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiation Oncology Associates P CGroup PAC ID 8527041771, 9 clinicians

Practice addresses (Care Compare)

7910 W Jefferson Blvd
Suite 110
Fort Wayne, IN 46804-4159
Phone (260) 436-4116

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.93 of 100Reported as individual
Quality
99.87
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Radiation Oncology Associates P C Radiation Oncology CurrentSince Aug 3, 2015 Accepting new patients

Locations

516 E Maumee St
Angola, IN 46703
Phone (219) 624-2120

11050 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (260) 266-7100

7910 W Jefferson Blvd
Ste 110
Fort Wayne, IN 46804
Phone (260) 436-4116

1520 Provident Dr
Warsaw, IN 46580
Phone (260) 434-6447

Interoperability endpoints

  • Direct secure messaging: ncannon85847@direct.parkviewexchange.com

Organizations & group practices 1

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 5

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": "1282003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1225343072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7910 W JEFFERSON BLVD STE 110",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044159",
            "telephone_number": "260-436-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 PARKVIEW CIRCLE DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46845",
            "telephone_number": "260-266-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "NATHAN",
        "middle_name": "ALLEN",
        "credential": "M.D./PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-17",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IN",
            "license": "01075113A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201292540",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0134869",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.