Individual provider Active NPI

Kevin Cannon, M.D.

  • Hospitalist Physician
  • Wilmington, NC
National Provider Identifier
1700897022
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
13188 Issued in NC
Practice address
1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone
(910) 341-3300
Fax
(910) 251-8824
NPI assigned
Aug 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 13188 NC Primary

Addresses

Primary practice location

1202 Medical Center Dr
Wilmington, NC 28401-7307

Mailing address

1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone (910) 341-3300

Other identifiers 3

IdentifierTypeStateIssuer
891287JMedicaidNC
110224267OtherNCRAILROAD MEDICARE
1287JOtherNCBCBS NC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100114000718 NC Practitioner - Internal Medicine 7911049820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Virginia Commonwealth University, School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wilmington Health PLLCGroup PAC ID 6103722509, 364 clinicians

Practice addresses (Care Compare)

1202 Medical Ctr Dr
Wilmington, NC 28401-7307
Phone (910) 341-1540

1222 Medical Ctr Dr
Wilmington, NC 28401-7307
Phone (910) 341-1540

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13188NCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmington Health PLLC CurrentSince Aug 1, 2001 Accepting new patients
Wilmington ASC LLC CurrentSince Aug 1, 2001 Accepting new patients
Wha Medical Clinic PLLC Current Accepting new patients

Locations

1300 Bridge Barrier Rd
Ste 2
Carolina Beach, NC 28428
Phone (910) 458-4101

1333 S Dickinson Dr
Leland, NC 28451
Phone (910) 332-0241

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

8108B Market St
Wilmington, NC 28411
Phone (910) 686-2099

1202 Medical Center Dr
Wilmington, NC 28401
Phone (910) 617-6705

8108 Market St
#B
Wilmington, NC 28411
Phone (910) 686-2099

2511 Delaney Ave
Wilmington, NC 28403
Phone (910) 667-9328

Interoperability endpoints

  • Direct secure messaging: kevin.cannon.p1@direct.wilmingtonhealth.nextgenshare.com

Organizations & group practices 3

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 1

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1700897022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-341-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "KEVIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "13188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891287J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110224267",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "1287J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.