NPIMap

Individual provider Active NPI

Jeremy David Cannell, M.D.

  • Diagnostic Radiology Physician
  • Bedford, NH
National Provider Identifier
1386888733
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
23657 Issued in NH
Practice address
703 Riverway PL
Bedford, NH 03110-6745
Phone
(603) 627-1661
Fax
(603) 669-6944
NPI assigned
Apr 29, 2009
Last updated
Sep 8, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 23657 NH Primary

Addresses

Primary practice location

703 Riverway PL
Bedford, NH 03110-6745

Mailing address

703 Riverway PL
Bedford, NH 03110-6745
Phone (603) 627-1661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, NH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180709001720 OR Practitioner - Diagnostic Radiology 8325349665 Reassigns benefits to 2 organizations
I20230303001473 NH Practitioner - Diagnostic Radiology 8325349665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Texas Medical School at San Antonio, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern New Hampshire Radiology Consultants PCGroup PAC ID 2769436088, 39 clinicians

Practice addresses (Care Compare)

4588 NE Cleveland Ave
Portland, OR 97211-2710
Phone (860) 289-3375

703 Riverway PL
Bedford, NH 03110-6768
Phone (603) 627-1661

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tuality Medical Group LLC CurrentSince Jan 1, 2020 Accepting new patients
Tuality Healthcare Current Accepting new patients
Tuality Medical Group LLC CurrentSince Jan 1, 2020 Accepting new patients
Southern New Hampshire Radiology Consultants PC Diagnostic Radiology CurrentSince Mar 20, 2023 Accepting new patients

Locations

11 Washington Pl
Bedford, NH 03110
Phone (603) 622-3670

4 Hawthorne Dr
Bedford, NH 03110
Phone (603) 472-8888

703 Riverway Pl
Bedford, NH 03110
Phone (603) 668-7096

59 Page Hill Rd
Berlin, NH 03570
Phone (603) 752-2200

1 Elliot Way
Manchester, NH 03103
Phone (603) 663-2271

100 McGregor St
Manchester, NH 03102
Phone (603) 663-6931

8 Prospect St
Nashua, NH 03060
Phone (603) 281-9275

452 Old Street Rd
Peterborough, NH 03458
Phone (603) 924-4699

101 Boulder Point Dr
Ste 1
Plymouth, NH 03264
Phone (603) 238-3537

16 Hospital Rd
Plymouth, NH 03264
Phone (603) 238-2229

335 SE 8th Ave
Hillsboro, OR 97123
Phone (503) 681-1111

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1240963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1386888733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 RIVERWAY PL",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106745",
            "telephone_number": "603-627-1661",
            "fax_number": "603-669-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 RIVERWAY PL",
            "city": "BEDFORD",
            "state": "NH",
            "postal_code": "031106745",
            "telephone_number": "603-627-1661",
            "fax_number": "603-669-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNELL",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-29",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NH",
            "license": "23657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, NH

Sources for this page

Verify at the official NPI Registry.