Individual provider Active NPI

Aileen Carol Cannon, M.D.

  • Pediatrics Physician
  • Tampa, FL
National Provider Identifier
1841233434
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME114340 Issued in FL
Practice address
4202 E Fowler Ave
SHS 100
Tampa, FL 33620-6750
Phone
(813) 974-2331
NPI assigned
Jun 13, 2006
Last updated
Jan 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME114340 FL Primary

Addresses

Primary practice location

4202 E Fowler Ave
SHS 100
Tampa, FL 33620-6750

Mailing address

PO Box 917770
Orlando, FL 32891-0001
Phone (813) 974-2201

Other identifiers 3

IdentifierTypeStateIssuer
02611136MedicaidNY
14N3QOtherFLBLUE CROSS BLUE SHIELD
006793600MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address acannon91549@direct.tgh.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121116000471 FL Practitioner - Internal MedicinePractitioner - Pediatric Medicine 6507824471 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4202 E Fowler Ave
Tampa, FL 33620-6750

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
University Medical Service Association Inc CurrentSince Oct 30, 2012 Accepting new patients
University Medical Service Association Inc Internal Medicine CurrentSince Oct 30, 2012 Accepting new patients
University Medical Service Association Inc Current Accepting new patients
University Medical Service Association Inc Past Accepting new patients

Locations

12901 Bruce B Downs Blvd
#62
Tampa, FL 33612

4202 E Fowler Ave
Stop SHS100
Tampa, FL 33620
Phone (813) 974-2331

Interoperability endpoints

  • Direct secure messaging: acannon91549@direct.tgh.org
  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1841233434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328910001",
            "telephone_number": "813-974-2201",
            "fax_number": "813-974-2812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 E FOWLER AVE",
            "address_2": "SHS 100",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336206750",
            "telephone_number": "813-974-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "AILEEN",
        "middle_name": "CAROL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME114340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02611136",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "14N3Q",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006793600",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "acannon91549@direct.tgh.org",
            "affiliation": "N",
            "address_1": "4202 E Fowler Ave",
            "address_2": "SHS 100",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336206750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.