NPIMap

Individual provider Active NPI

Roan Sumner Gannon, M.D.

  • Family Medicine Physician
  • Albertville, AL
National Provider Identifier
1548529902
Registry record updated Apr 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
33074 Issued in AL
Practice address
5104 US Highway 431
Albertville, AL 35950-0237
Phone
(256) 878-8180
Fax
(256) 891-3693
NPI assigned
May 4, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 33074 AL Primary

Addresses

Primary practice location

5104 US Highway 431
Albertville, AL 35950-0237

Mailing address

5104 US Highway 431
Albertville, AL 35950-0237
Phone (256) 878-8180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20150717000724 AL Practitioner - Family Practice 9537472774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sand Mountain Family Practice Center, P. C.Group PAC ID 7517980493, 5 clinicians

Practice addresses (Care Compare)

5104 US Hwy 431
Albertville, AL 35950-0237
Phone (256) 878-8184

Hospital & facility affiliations

  • Medical Centers Homecare Home health agency, Albertville, AL, CCN 017128
  • Enhabit Home Health Home health agency, Hoover, AL, CCN 017009
  • Centerwell Home Health Home health agency, Rainbow City, AL, CCN 017018
  • Madison Home Health Services, LLC Home health agency, Huntsville, AL, CCN 017880
  • Prohealth Home Health, LLC Home health agency, Huntsville, AL, CCN 017178
  • Marshall Medical Centers Hospital, Boaz, AL, CCN 010005
  • Huntsville Hospital Hospital, Huntsville, AL, CCN 010039

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions27
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sand Mountain Family Practice Center, P. C. Family Medicine CurrentSince Jul 6, 2015 Accepting new patients

Locations

5104 US Highway 431
Albertville, AL 35950
Phone (256) 878-8180

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19522/brand/1/csg/1/fhir/r4
  • Direct secure messaging: roan.gannon.sandmountainfamilypractice@smfp.direct.systemedx.com

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 7

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": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1548529902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 US HIGHWAY 431",
            "city": "ALBERTVILLE",
            "state": "AL",
            "postal_code": "359500237",
            "telephone_number": "256-878-8180",
            "fax_number": "256-891-3693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 US HIGHWAY 431",
            "city": "ALBERTVILLE",
            "state": "AL",
            "postal_code": "359500237",
            "telephone_number": "256-878-8180",
            "fax_number": "256-891-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "ROAN",
        "middle_name": "SUMNER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-04",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "33074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albertville, AL

Sources for this page

Verify at the official NPI Registry.