Addy Antley Cannon, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

TL1562 Issued in SC

Practice address

126 Dillon Drive
Spartanburg, SC 29307-1018

Phone

(864) 327-1212

Fax

(864) 327-1211

NPI assigned

Oct 15, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Addy Antley Smoke Former name

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foothills Nephrology PCGroup PAC ID 0244122521, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Foothills Nephrology PC

  • Nephrology Physician
  • Spartanburg, SC
  • NPI 1528025137
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1386954097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 DILLON DRIVE",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071018",
            "telephone_number": "864-327-1212",
            "fax_number": "864-327-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 DILLON DRIVE",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071018",
            "telephone_number": "864-327-1212",
            "fax_number": "864-327-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "ADDY",
        "middle_name": "ANTLEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "TL1562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ADDY",
            "last_name": "SMOKE",
            "middle_name": "ANTLEY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Campbell
• Patricia S Campbell, NP-C
• Rebecca K Campbell, PHARM.D.
• Suzzanne Mabel Candelaria Perez, DC
• Lidia Cannalunga, PT, DPT
• Cecilia S. Cannon, P.A.
• Hayley Cannon, LMSW
• Matthew David Cannon, D.O.
• Ralph Donald Cannon Jr., RPH
• Stephanie Cannon, FNP-C

• Medical Physician Assistant in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.