Individual provider Active NPI

Paul B Cannon, DPM

  • Foot & Ankle Surgery Podiatrist
  • Falls Church, VA
National Provider Identifier
1740285022
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
0103300931 Issued in VA
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

Updated by the provider on Dec 7, 2007

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050421001563 DC Practitioner - Podiatry 8921046665 Reassigns benefits to 1 organization

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
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

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

ProcedureNumber of procedures
Removal of tissue109
Removal of skin lesions35
Removal of nail tissue701
Removal or shaving of skin growth296

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PO1000043DCMDFoot & Ankle Surgery Podiatrist
016-005169ILMDFoot & Ankle Surgery Podiatrist
0103300931VAMDFoot & Ankle Surgery Podiatrist
01424MDMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Jan 12, 2019 Accepting new patients
Privia Medical Group, LLC Foot & Ankle Surgery CurrentSince Jan 12, 2019 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

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: 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.

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": "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

Verify at the official NPI Registry.