NPIMap

Individual provider Active NPI

Douglas Todd Cannon, MD

  • Physical Medicine & Rehabilitation Physician
  • Cordova, TN
National Provider Identifier
1376569210
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
50010 Issued in TN
Practice address
8000 Centerview Pkwy
Suite 500
Cordova, TN 38018-4227
Phone
(901) 759-3100
Fax
(901) 759-3196
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 27

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.

View all 27

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Washington University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell Clinic, PC 229 clinicians

Practice addresses (Care Compare)

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

7545 Airways Blvd
Southaven, MS 38671-5806
Phone (901) 759-3196

Hospital & facility affiliations

  • Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
  • Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20130805000074 TN Practitioner - Physical Medicine and RehabilitationPractitioner - Orthopedic Surgery 9739267683 Reassigns benefits to 1 organization
I20140609000241 MS Practitioner - Physical Medicine and Rehabilitation 9739267683 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50010TNMDPhysical Medicine & Rehabilitation Physician
22876MSMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Clinic, PC Physical Medicine & Rehabilitation CurrentSince Aug 1, 2013 Accepting new patients
Campbell Clinic PC CurrentSince Aug 1, 2013 Accepting new patients
North County Associates, LLC PastSince Jan 1, 2004 Accepting new patients
Campbell Clinic Past Accepting new patients
CC Bpci PLC Past Accepting new patients

Locations

6760 Goodman Rd
Ste 110
Olive Branch, MS 38654

7545 Airways Blvd
Southaven, MS 38671
Phone (901) 759-3196

11851 Will Harris Dr
Arlington, TN 38002
Phone (901) 430-8263

1458 W Poplar Ave
Ste 100
Collierville, TN 38017
Phone (901) 759-5491

1900 W Poplar Ave
Collierville, TN 38017
Phone (901) 759-5491

1535 Vann Dr
Jackson, TN 38305
Phone (731) 984-9944

7887 Wolf River Blvd
Memphis, TN 38138
Phone (901) 759-3180

1211 Union Ave
Ste 500
Memphis, TN 38104
Phone (901) 759-3275

1400 S Germantown Rd
Memphis, TN 38138
Phone (901) 759-3111

585 S Mendenhall Rd
Memphis, TN 38117

Interoperability endpoints

  • Direct secure messaging: douglas.cannon.1@1366.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/1366/brand/1/csg/1/fhir/r4
  • Direct secure messaging: dtcannon@cco1043.srs-direct.com

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 22876 MS
Physical Medicine & Rehabilitation Physician 208100000X 50010 TN Primary

Addresses

NPPES NPI Registry

Primary practice location

8000 Centerview Pkwy
Suite 500
Cordova, TN 38018-4227

Mailing address

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

Other practice location 1

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-3100

Other practice location 2

1211 Union Ave Ste 500
Memphis, TN 38104-6656
Phone (901) 759-3100

Other practice location 3

1458 W Poplar Ave Ste 100
Collierville, TN 38017-0630
Phone (901) 759-3100

Other practice location 4

7545 Airways Blvd
Southaven, MS 38671-5806
Phone (901) 759-3100

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
05254852MedicaidMS
Q004010MedicaidTN
199076001MedicaidAR
100295624MedicaidMS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 16, 2023.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1376569210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-3100",
            "fax_number": "901-759-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 CENTERVIEW PKWY",
            "address_2": "SUITE 500",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380184227",
            "telephone_number": "901-759-3100",
            "fax_number": "901-759-3196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 S Germantown Rd",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381382205",
            "country_code": "US",
            "telephone_number": "901-759-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1211 Union Ave Ste 500",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381046656",
            "country_code": "US",
            "telephone_number": "901-759-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1458 W Poplar Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Collierville",
            "state": "TN",
            "postal_code": "380170630",
            "country_code": "US",
            "telephone_number": "901-759-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7545 Airways Blvd",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386715806",
            "country_code": "US",
            "telephone_number": "901-759-3100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "DOUGLAS",
        "middle_name": "TODD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MS",
            "license": "22876",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TN",
            "license": "50010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05254852",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q004010",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199076001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100295624",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

Verify at the official NPI Registry.