Ty Cannon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10974132-1206 Issued in UT

Practice address

616 S River Rd Ste 200
St George, UT 84790-2105

Phone

(435) 628-8944

NPI assigned

Sep 25, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Pacific Medical Associates PC

  • Internal Medicine Physician
  • St George, UT
  • NPI 1912307901
  Medicare reassignment

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1417432501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N 1100 E UNIT 50",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847802883",
            "telephone_number": "435-231-2961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S RIVER RD STE 200",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847902105",
            "telephone_number": "435-628-8944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "TY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-25",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10974132-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Canchola
• Luis Canepa
• Daniel Cannon, M.D.
• Rylee Dawn Cannon
• Sydnee Cannon
• Victoria Cannon, BEHAVIOR TECHNICIAN
• Canyonlands Health Care Special Service District
• Canyonlands Medical LC
• Canyons Family Wellness, LLC
• Joseph Caplan

• Physician Assistant in St George, UT
• Providers in St George, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.