NPIMap

Individual provider Active NPI

Jessica A Cannon, ANP

  • Adult Health Nurse Practitioner
  • Columbia, SC
National Provider Identifier
1679586028
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
1914 Issued in SC
Practice address
400 Palmetto Health Pkwy
Columbia, SC 29212-1760
Phone
(803) 434-6771
NPI assigned
Aug 15, 2006
Last updated
Jan 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1914 SC
Adult Health Nurse Practitioner 363LA2200X 1914 SC Primary

Addresses

Primary practice location

400 Palmetto Health Pkwy
Columbia, SC 29212-1760

Mailing address

PO Box 743904
Atlanta, GA 30374-3904

Other practice location 1

2669 Kinard St
Newberry, SC 29108-2911
Phone (803) 405-7148

Other identifiers 1

IdentifierTypeStateIssuer
NP1514MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20091119000057 SC Practitioner - Nurse Practitioner 4688712227 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Medical University of South Carolina College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

14 Richland Medical Park Dr
Suite 320
Columbia, SC 29203-6896
Phone (803) 434-6771

1612 Chapin Rd
Chapin, SC 29036-9304
Phone (843) 792-1414

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1914SCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Oct 1, 2025 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Mar 1, 2020 Accepting new patients
Musc Community Physicians CurrentSince Oct 1, 2025 Accepting new patients
Prisma Health Medical Group-Midlands Current Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Mar 1, 2020 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1612 Chapin Rd
Chapin, SC 29036
Phone (803) 345-3414

14 Richland Medical Park Dr
Ste 320
Columbia, SC 29203
Phone (803) 434-1663

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

400 Palmetto Health Pkwy
Columbia, SC 29212
Phone (803) 296-5579

1830 Pondfield Rd
Ste A1
Newberry, SC 29108
Phone (803) 405-7140

2669 Kinard St
Newberry, SC 29108
Phone (803) 276-7570

115 N Sumter St
Ste 110
Sumter, SC 29150
Phone (803) 774-5249

129 N Washington St
Sumter, SC 29150
Phone (803) 774-1752

Interoperability endpoints

  • Direct secure messaging: jcannon378287@direct.ghs.myhfn.org
  • Direct secure messaging: jcannon549190@direct.musc.edu

Organizations & group practices 6

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1679586028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743904",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 PALMETTO HEALTH PKWY",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292121760",
            "telephone_number": "803-434-6771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2669 Kinard St",
            "address_purpose": "LOCATION",
            "city": "Newberry",
            "state": "SC",
            "postal_code": "291082911",
            "country_code": "US",
            "telephone_number": "803-405-7148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "JESSICA",
        "middle_name": "A",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "1914",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "1914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1514",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.