NPIMap

Individual provider Active NPI

Christopher E Cannon, MD

  • Interventional Cardiology Physician
  • Medford, OR
National Provider Identifier
1487650586
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD155248 Issued in OR
Practice address
1698 E. McAndrews Rd,
Suite 300
Medford, OR 97504-5590
Phone
(541) 732-7850
Fax
(541) 732-7851
NPI assigned
Jun 23, 2005
Last updated
Jan 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD155248 OR
Interventional Cardiology Physician 207RI0011X MD155248 OR Primary

Addresses

Primary practice location

1698 E. McAndrews Rd,
Suite 300
Medford, OR 97504-5590

Mailing address

PO Box 3158
Portland, OR 97208-3158
Phone (541) 732-7850

Other identifiers 1

IdentifierTypeStateIssuer
500635923MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180912001831 CO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Interventional Cardiology 1254482813 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Interventional Cardiology
Education
Brody School of Medicine at East Carolina University, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Platte Valley Medical Group LLCGroup PAC ID 5890054100, 120 clinicians

Practice addresses (Care Compare)

1600 Prairie Ctr Pkwy
Brighton, CO 80601-4006
Phone (303) 498-1600

1610 Prairie Ctr Pkwy
Brighton, CO 80601-4003

1818 N Ogden St
Suite 400
Denver, CO 80218-1280
Phone (303) 318-2460

217 N 50TH Ave
Brighton, CO 80601-8364
Phone (303) 659-1152

4859 Yampa St
Denver, CO 80249-7760
Phone (303) 498-1885

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting11
Varicose vein removal29

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Cardiovascular Disease Current Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jun 25, 2019 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jun 25, 2019 Accepting new patients
Platte Valley Medical Group, LLC CurrentSince Sep 30, 2018 Accepting new patients
Platte Valley Medical Group, LLC CurrentSince Sep 30, 2018 Accepting new patients
Roanoke Valley Cardiology Associates PastSince Aug 18, 2010 Accepting new patients
Platte Valley Medical Group LLC Interventional Cardiology Past Accepting new patients

Locations

23750 E 14th Ave
Ste 310
Aurora, CO 80018
Phone (303) 272-0500

500 Eldorado Blvd
Ste 6300
Broomfield, CO 80021
Phone (303) 272-0803

1818 N Ogden St
Ste 400
Denver, CO 80218
Phone (303) 318-2440

4859 Yampa St
Denver, CO 80249
Phone (303) 498-1885

1000 Lincoln St
Fort Morgan, CO 80701
Phone (970) 542-3320

300 Exempla Cir
Ste 310
Lafayette, CO 80026
Phone (303) 272-0500

13421 Quebec St
Thornton, CO 80602
Phone (303) 498-2850

Organizations & group practices 7

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 12

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1487650586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3158",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083158",
            "telephone_number": "541-732-7850",
            "fax_number": "541-732-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 E. MCANDREWS RD,",
            "address_2": "SUITE 300",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975045590",
            "telephone_number": "541-732-7850",
            "fax_number": "541-732-7851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "CHRISTOPHER",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD155248",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OR",
            "license": "MD155248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500635923",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.