Octavia Manetta Cannon, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

5101012864 Issued in MI

Practice address

1560 Turf LN
East Lansing, MI 48823-6392

Phone

(517) 484-3000

NPI assigned

Jan 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC, MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Obstetrics/Gynecology

Education

Nova Southeastern College of Osteo Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uwh of Michigan PLCGroup PAC ID 0345626073, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230
• McLaren Greater Lansing Hospital, Lansing, MI, CCN 230167

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: octavia.cannon.1@26060.direct.athenahealth.com

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.

• Uwh of Michigan PLC

  • Obstetrics & Gynecology Physician
  • East Lansing, MI
  • NPI 1982352357
  Medicare reassignment Care Compare group
• Metro Partners in Womens Health, PC

  • Obstetrics & Gynecology Physician
  • Novi, MI
  • NPI 1083601082
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1073588711
  Care Compare affiliation
• Edward W Sparrow Hospital Association

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1760710719
  Care Compare affiliation
• McLaren Greater Lansing

  • General Acute Care Hospital
  • Lansing, MI
  • NPI 1134104672
  Care Compare affiliation

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1497734701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 TURF LN",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488236392",
            "telephone_number": "517-484-3000",
            "fax_number": "517-484-6358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 TURF LN",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488236392",
            "telephone_number": "517-484-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3125 Springbank Ln",
            "address_2": "SUITE B",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282263345",
            "country_code": "US",
            "telephone_number": "704-341-1103 x107",
            "fax_number": "704-341-3460",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 S Cedar St",
            "address_purpose": "LOCATION",
            "city": "Mason",
            "state": "MI",
            "postal_code": "488542009",
            "country_code": "US",
            "telephone_number": "517-484-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "OCTAVIA",
        "middle_name": "MANETTA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-13",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "9900020",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "99-00020",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "5101012864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN PHYSICIAN LICENSE",
            "identifier": "5101012864",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891197H",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cannnon@allscriptsdirectmessage.com",
            "affiliation": "N",
            "address_1": "1560 Turf Ln",
            "city": "East Lansing",
            "state": "MI",
            "country_code": "US",
            "postal_code": "488236392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rachel Cameron, MD
• Campbell Therapy Services PLLC
• Marlie Patel Campbell, DO
• Cannon Wellness Collective PLLC
• Ebony Cannon
• Zana Cannon
• Ashlea Catherine Cantu
• Cristina Capitanio
• Capitol Area Physical Therapy Associates, Inc.
• Capitol Area Physical Therapy Associates, Inc.

• Obstetrics & Gynecology Physician in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.