Courtney Cannon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10020 Issued in MN

Practice address

914 S 8TH St
S100
Minneapolis, MN 55404-1210

Phone

(612) 347-5871

NPI assigned

Jul 26, 2006

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

Medicare fee-for-service enrollment

Enrolled in MN

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, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emily Program P CGroup PAC ID 5193623254, 49 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Emily Program P C

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • St Paul, MN
  • NPI 1528165065
  Medicare reassignment Care Compare group
• Hennepin Faculty Associates

  • General Practice Physician
  • Minneapolis, MN
  • NPI 1063459485
  NPD (past)
• Life Clinic Medical, PA

  • Internal Medicine Physician
  • St Louis Park, MN
  • NPI 1942546692
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487678124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 S 8TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 S 8TH ST",
            "address_2": "S100",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041210",
            "telephone_number": "612-347-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "COURTNEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candor Home Health Care LLC
• Amy Elizabeth Candy, M.D.
• Cannon Chiropractic LLC
• Annette N Cannon, D.C.
• Athena Brindle Cannon
• Sarah Joanna Cano, M.D.
• Amy Elizabeth Cantazaro, PH.D., LP
• Angela Cao
• Kevin Pan Cao, MD
• Joanna Denise Capecchi, NP

• Physician Assistant in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.