Individual provider Active NPI

Gannon Tissot, PA

  • Physician Assistant
  • Columbia, TN
National Provider Identifier
1417813692
Registry record updated Dec 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1050 N James M Campbell Blvd Ste 200
Columbia, TN 38401-2754
Phone
(931) 381-2663
NPI assigned
Dec 31, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X TN Primary

Addresses

Primary practice location

1050 N James M Campbell Blvd Ste 200
Columbia, TN 38401-2754

Mailing address

PO Box 306556
Nashville, TN 37230-6556
Phone (615) 329-2294

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20260327000397 TN Practitioner - Physician Assistant 2062997133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tennessee Orthopaedic Alliance PAGroup PAC ID 5193625069, 358 clinicians

Practice addresses (Care Compare)

1050 N James M Campbell Blvd
Suite 200
Columbia, TN 38401-2754
Phone (931) 381-2663

Hospital & facility affiliations

  • Maury Regional Hospital Hospital, Columbia, TN, CCN 440073

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1767139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767139200000",
    "number": "1417813692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306556",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306556",
            "telephone_number": "615-329-2294",
            "fax_number": "615-694-7907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 N JAMES M CAMPBELL BLVD STE 200",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384012754",
            "telephone_number": "931-381-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISSOT",
        "first_name": "GANNON",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-12-31",
        "last_updated": "2025-12-31",
        "certification_date": "2025-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, TN

Sources for this page

Verify at the official NPI Registry.