NPIMap

Individual provider Active NPI

Austin Ron Cannon, MD

  • Surgery Physician
  • Murray, UT
National Provider Identifier
1790179653
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
10086826-1205 Issued in UT
Practice address
5121 S Cottonwood St
Murray, UT 84107-5701
Phone
(801) 507-7000
NPI assigned
Mar 27, 2015
Last updated
Oct 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 10086826-1205 UT Primary

Addresses

Primary practice location

5121 S Cottonwood St
Murray, UT 84107-5701

Mailing address

7417 S Rich Way
Cottonwood Heights, UT 84121-4840
Phone (919) 608-2404

Other identifiers 1

IdentifierTypeStateIssuer
10086826OtherUTSTATE OF UTAH ACTIVE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230209001380 UT Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 8426338864 Reassigns benefits to 1 organization
I20251230003488 NV Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 8426338864 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Colorectal Surgery (Proctology)
Education
University of North Carolina at Chapel Hill School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gomez Kozar McElreath and Smith Professional CorporationGroup PAC ID 1759369101, 26 clinicians
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

18653 Wedge Pkwy
Reno, NV 89511-3323
Phone (775) 323-7500

5169 S Cottonwood St
Suite 410
Murray, UT 84107-6769
Phone (801) 507-1600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy17
Hernia repair - groin (open)1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10086826-1205UTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. Multi-Specialty CurrentSince Nov 3, 2022 Accepting new patients
Ihc Health Services Inc CurrentSince Nov 3, 2022 Accepting new patients
Gomez Kozar McElreath Smith Multi-Specialty CurrentSince Jan 5, 2026 Accepting new patients
Ihc Health Services Inc Multi-Specialty Current Accepting new patients

Locations

1375 Vista Ln
Carson City, NV 89703
Phone (775) 786-4200

18653 Wedge Pkwy
Reno, NV 89511
Phone (775) 770-7210

75 Pringle Way
Ste 1002
Reno, NV 89502
Phone (702) 323-7500

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

5169 S Cottonwood St
Ste 410
Salt Lake City, UT 84107
Phone (801) 507-1600

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 4

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1790179653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7417 S RICH WAY",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "841214840",
            "telephone_number": "919-608-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5121 S COTTONWOOD ST",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075701",
            "telephone_number": "801-507-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "AUSTIN",
        "middle_name": "RON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-27",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "UT",
            "license": "10086826-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF UTAH ACTIVE LICENSE",
            "identifier": "10086826",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.