Samuel Harrison Cannon Jr., CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

041353866 Issued in IL

Practice address

N2950 State Road 67
Lake Geneva, WI 53147-2655

Phone

(262) 245-0535

NPI assigned

Mar 27, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Mercy Health System CorporationGroup PAC ID 7416860440, shared by 14 NPIs, 749 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Aurora Medical Center Kenosha Hospital, Kenosha, WI, CCN 520189
• Mercy Walworth Hospital & Medical Center Hospital, Lake Geneva, WI, CCN 521357

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: scannon265087@direct.myadvocateaurora.org

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.

• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Brookfield Anesthesiologists, S.C.

  • Anesthesiology Physician
  • Brookfield, WI
  • NPI 1942257902
  Medicare reassignment NPD
• Mercy Health System Corporation

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603
  Medicare reassignment NPD
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Medicare reassignment NPD
• Polykarpos Anesthesia LLC

  • Anesthesiology Physician
  • Pleasant Prairie, WI
  • NPI 1154850972
  Medicare reassignment NPD
• Stateline Anesthesiologists SC

  • Anesthesiology Physician
  • Beloit, WI
  • NPI 1316937519
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD
• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD
• Chad Novasic PT LTD

  • Physical Therapist
  • Racine, WI
  • NPI 1578679890
  NPD (past)

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

• Aurora Health Care Southern Lakes, Inc.

  • General Acute Care Hospital
  • Kenosha, WI
  • NPI 1225156888
  Care Compare affiliation
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Care Compare affiliation

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1831432996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29624 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731296",
            "telephone_number": "608-756-6278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2950 STATE ROAD 67",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472655",
            "telephone_number": "262-245-0535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3302 WEMBLEY DR",
            "address_purpose": "LOCATION",
            "city": "ZION",
            "state": "IL",
            "postal_code": "60099",
            "country_code": "US",
            "telephone_number": "847-977-3483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "SAMUEL",
        "middle_name": "HARRISON",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-27",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "041353866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100042105",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scannon265087@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3302 WEMBLEY DR",
            "city": "ZION",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3302 WEMBLEY DR",
            "city": "ZION",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeffrey Gene Buntrock, DC
• Taylor Busalacchi, PT
• Theresa Butler
• Kerri Caan, DDS
• Daniel R Caminiti, LPC
• Caregiver Associates, LLC
• Kali R Carlson, MOT, OTR/L
• Beulah Suzanne Carpenter, LMT
• Amy Carroll, PTA
• Brook Cash, RN

• Certified Registered Nurse Anesthetist in Lake Geneva, WI
• Providers in Lake Geneva, WI by specialty
• Certified Registered Nurse Anesthetist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.