NPIMap

Organization Active NPI

Cannon Memorial Hospital

Doing business as AnMed Cannon

  • General Acute Care Hospital
  • Pickens, SC
National Provider Identifier
1497744254
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
HTL-076 Issued in SC
Legal business name
CANNON MEMORIAL HOSPITAL
Doing business as
AnMed Cannon
Practice address
123 W G Acker Dr
Pickens, SC 29671-2739
Phone
(864) 878-4791
Fax
(864) 898-1047
NPI assigned
Oct 14, 2005
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Mr. Michael Cunningham
Title
President/Ceo
Phone
(864) 512-1109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HTL-076 SC Primary

Addresses

Primary practice location

123 W G Acker Dr
Pickens, SC 29671-2739

Mailing address

123 W G Acker Dr
Pickens, SC 29671-2739
Phone (864) 898-4791

Other identifiers 10

IdentifierTypeStateIssuer
CM6374OtherSCMEDICARE RAILROAD
205007MedicaidSC
400113MedicaidSC
4200011MedicaidNC
420011OtherSCMEDICARE INPATIENT
300017386AMedicaidGA
382878MedicaidSC
89066XHMedicaidNC
42-U011OtherSCMEDICARE SWING BED UNIT
420011OtherSCMEDICARE I/P & O/P

Other names 1

  • AnMed Cannon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115000729 SC Part B Supplier - Clinic/Group Practice 8123930666 Receives reassigned benefits from 45 practitioners
1 other NPI on this enrollment
Practice locations: Pickens, SC
O20080519000081 SC Part A Provider - Hospital 8123930666 Practice locations: Pickens, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497744254. Details of each certification follow.

Hospital certification: CCN 420011

Legal name
CANNON MEMORIAL HOSPITAL
Doing business as
ANMED CANNON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 19, 2021
Beds
55
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 27, 1950 in SC
Enrollment address
123 WG Acker Dr
Pickens, SC 29671-2739
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Cannon Memorial HospitalCCN 420011 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0253148Cannon Memorial Hospital123 W G Acker Dr, Pickens, SC 29671AccreditationJan 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cannon Memorial Hospital13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

123 Acker Dr
Pickens, SC 29671

123 Wg Acker Dr
Pickens, SC 29671
Phone (864) 512-2465

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Cassell Individual Corporate OfficerBoard Member Jan 1, 2011
Stephen J Grigsby Individual Corporate Director Apr 28, 2025
Robert Bradley Mock Individual Corporate OfficerBoard Member Jan 1, 2019
Michael Cunningham Individual W-2 Managing EmployeeCfo Jun 1, 2021
Operational/Managerial Control Jun 1, 2021
Harold Alexander Individual Corporate Director Feb 28, 2022
Zachary Hinton Individual Corporate OfficerBoard Member Mar 25, 2019
William Kenley Individual Corporate OfficerAnmed Health Ceo Sep 21, 2020
Corporate Director Sep 21, 2020
Scott Wesikittle Individual Corporate Director Aug 29, 2022
Cannon Memorial Hospital Organization, Pickens, SC Corporation 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Operational/Managerial Control Jan 1, 2014 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Cannon Memorial Hospital

    dba AnMed Primary Care - Easley

    • Rural Health Clinic/Center
    • Easley, SC
    • NPI 1700890084

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cannon Memorial Hospital

    dba AnMed Primary Care-Liberty

    • Family Medicine Physician
    • Liberty, SC
    • NPI 1750304135

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cannon Memorial Hospital

    dba AnMed Primary Care - Liberty

    • Rural Health Clinic/Center
    • Liberty, SC
    • NPI 1902224876

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anmed Primary Care - EasleyEasley, SC, CCN 423457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014
Anmed Primary Care - LibertyLiberty, SC, CCN 423462 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Cannon Memorial Hospital

    dba AnMed Primary Care - Easley

    • Rural Health Clinic/Center
    • Easley, SC
    • NPI 1700890084

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cannon Memorial Hospital

    dba AnMed Primary Care - Liberty

    • Rural Health Clinic/Center
    • Liberty, SC
    • NPI 1902224876

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

Affiliated clinicians 100

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1497744254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 W G ACKER DR",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296712739",
            "telephone_number": "864-898-4791",
            "fax_number": "864-899-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W G ACKER DR",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296712739",
            "telephone_number": "864-878-4791",
            "fax_number": "864-898-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANNON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "864-512-1109",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL-076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CM6374",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205007",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400113",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4200011",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INPATIENT",
            "identifier": "420011",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300017386A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382878",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89066XH",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SWING BED UNIT",
            "identifier": "42-U011",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE I/P & O/P",
            "identifier": "420011",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AnMed Cannon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pickens, SC

Sources for this page

Verify at the official NPI Registry.