NPIMap

Individual provider Active NPI

Mark Lawrence Cannon, MD

  • Infectious Disease Physician
  • Robbinsdale, MN
National Provider Identifier
1881805265
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
39619 Issued in MN
Practice address
3366 Oakdale Ave N
Robbinsdale, MN 55422-2948
Phone
(763) 520-5200
Fax
(763) 581-6401
NPI assigned
May 25, 2007
Last updated
Apr 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 206201 NY
Infectious Disease Physician 207RI0200X 4301061767 MI
Infectious Disease Physician 207RI0200X 39619 MN Primary

Addresses

Primary practice location

3366 Oakdale Ave N
Robbinsdale, MN 55422-2948

Mailing address

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 520-5200

Other identifiers 1

IdentifierTypeStateIssuer
1881805265MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mark.cannon@meg.eclinicaldirectplus.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080213000593 MN Practitioner - Infectious DiseasePractitioner - Internal Medicine 4587747522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Johns Hopkins University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

3366 Oakdale Ave N
Robbinsdale, MN 55422-2948
Phone (763) 520-5200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
206201NYMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince Jun 1, 2023 Accepting new patients
North Memorial Health Care Current Accepting new patients
North Memorial Health Care CurrentSince Jun 1, 2023 Accepting new patients

Locations

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

3366 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5281

Interoperability endpoints

  • Direct secure messaging: mcannon196816@direct.northmemorial.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1881805265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 OAKDALE AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222926",
            "telephone_number": "763-520-5200",
            "fax_number": "763-581-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 OAKDALE AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222948",
            "telephone_number": "763-520-5200",
            "fax_number": "763-581-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "MARK",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NY",
            "license": "206201",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MI",
            "license": "4301061767",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MN",
            "license": "39619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881805265",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark.cannon@meg.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1221 Sixth St Ste 206",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496842359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Robbinsdale, MN

Sources for this page

Verify at the official NPI Registry.