Michael Cannon, MD Personalized Medicine, LLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

MICHAEL CANNON, MD PERSONALIZED MEDICINE, LLC

Practice address

16216 Baxter Rd Ste 340
Chesterfield, MO 63017-4778

Phone

(314) 325-8925

NPI assigned

Sep 9, 2022

Organization subpart

No

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

Authorized official

Name

Michael CannonNPI 1154348761

Title

Owner/ MD

Phone

(314) 574-2851

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael E Cannon, MD

  • Family Medicine Physician
  • Chesterfield, MO
  • NPI 1154348761
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662681600000",
    "number": "1326769175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221240",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631228240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16216 BAXTER RD STE 340",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630174778",
            "telephone_number": "314-325-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL CANNON, MD PERSONALIZED MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/ MD",
        "authorized_official_telephone_number": "314-574-2851"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Elisabeth Meyer, CIT
• Katie Marie Meyerkord
• David G Meyers, MD
• Laura Leigh Meyers, MD
• Phillip Robert Meyers
• Michael F Grasso DDS & Associates PC
• Michael V Oliveri
• Michael W. Noble DMD PC
• Bryan J Micklevitz, PHARMD
• Mid West Clinical Practice LLC

• Sports Medicine (Family Medicine) Physician in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Sports Medicine (Family Medicine) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.