NPIMap

Organization Active NPI

Mpac SMH of California PC

  • Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1821660960
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MPAC SMH OF CALIFORNIA PC
Practice address
200 N la Salle St Ste 1550
Chicago, IL 60601-1034
Phone
(888) 705-8722
Fax
(888) 705-8722
NPI assigned
Jul 16, 2021
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Dr. Sean C Cannone, DO
Title
Owner
Phone
(330) 328-3167

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

200 N la Salle St Ste 1550
Chicago, IL 60601-1034

Mailing address

PO Box 80694
City of Industry, CA 91716-8415
Phone (888) 705-8722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211130001905 CA Part B Supplier - Clinic/Group Practice 6002206380 Receives reassigned benefits from 32 practitioners
Practice locations: Pittsburg, CA; Riverside, CA; Pomona, CA; Santa Ana, CA; Tarzana, CA; Tujunga, CA; Van Nuys, CA; Vista, CA…

National Provider Directory

National Provider Directory

Locations

1720 W Orange Ave
Anaheim, CA 92804
Phone (714) 776-1720

7716 Pickering Ave
Whittier, CA 90602
Phone (562) 693-5240

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1821660960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80694",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168415",
            "telephone_number": "888-705-8722",
            "fax_number": "888-705-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N LA SALLE ST STE 1550",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606011034",
            "telephone_number": "888-705-8722",
            "fax_number": "888-705-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MPAC SMH OF CALIFORNIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-16",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "CANNONE",
        "authorized_official_first_name": "SEAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-328-3167",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.