Active NPI
Paul B Cannon, DPM
- Foot & Ankle Surgery Podiatrist
- Falls Church, VA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 0103300931
- Practice address
- 104A E Broad St
Falls Church, VA 22046-4501 - Phone
- (703) 237-1555
- Fax
- (703) 237-2253
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 0103300931 | VA | Primary |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 01424 | MD | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | PO1000043 | DC | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | IL |
Addresses
Primary practice location
104A E Broad St
Falls Church, VA 22046-4501
Mailing address
104A E Broad St
Falls Church, VA 22046-4501
Phone (703) 237-1555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- William M. Scholl College of Podiatric Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
104 A E Broad St
Falls Church, VA 22046-4501
Phone (703) 237-1555
104 E Broad St
Suite a
Falls Church, VA 22046-4501
Phone (703) 237-1555
9470 Annapolis Rd
Suite 309
Lanham, MD 20706-3022
Phone (202) 832-1800
950 N Glebe Rd
Suite 700
Arlington, VA 22203-4173
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 109 |
| Removal of skin lesions | 35 |
| Removal of nail tissue | 701 |
| Removal or shaving of skin growth | 296 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO1000043 | DC | MD | Foot & Ankle Surgery Podiatrist |
| 016-005169 | IL | MD | Foot & Ankle Surgery Podiatrist |
| 0103300931 | VA | MD | Foot & Ankle Surgery Podiatrist |
| 01424 | MD | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Privia Medical Group, LLC | Current | Accepting new patients | |
| Privia Medical Group, LLC | Foot & Ankle Surgery | Current | Accepting new patients |
| Nova Physician Wellness Center PLLC | Past | Accepting new patients |
Locations
9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800
950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065
104A E Broad St
Falls Church, VA 22046
Phone (703) 237-1555
104 E Broad St
#A
Falls Church, VA 22046
Phone (703) 237-1555
Interoperability endpoints
- https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
- paul.cannon.1@8042.direct.athenahealth.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.
-
- Internal Medicine Physician
- Arlington, VA
- NPI 1013042480
DC, Foot & Ankle Surgery
-
- Pain Medicine (Psychiatry & Neurology) Physician
- Rockville, MD
- NPI 1811715436
-
- Family Medicine Physician
- Fairfax, VA
- NPI 1215307400
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Arlington, VA
- NPI 1790785996
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196985600000",
"number": "1740285022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104A E BROAD ST",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220464501",
"telephone_number": "703-237-1555",
"fax_number": "703-237-2253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104A E BROAD ST",
"city": "FALLS CHURCH",
"state": "VA",
"postal_code": "220464501",
"telephone_number": "703-237-1555",
"fax_number": "703-237-2253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "PAUL",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2007-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "VA",
"license": "0103300931",
"primary": true
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "MD",
"license": "01424",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "DC",
"license": "PO1000043",
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "IL",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Falls Church, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; 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.