NPIMap

Organization Active NPI

Charles a. Cannon Jr. Memorial Hospital

Doing business as Cannon Medical Associates

  • Medical Specialty Clinic/Center
  • Linville, NC
National Provider Identifier
1912002189
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
H0037 Issued in NC
Legal business name
CHARLES A. CANNON JR. MEMORIAL HOSPITAL
Doing business as
Cannon Medical Associates
Practice address
436 Hospital Dr, Sloop Medical Office Plaza
Suite 210
Linville, NC 28646
Phone
(828) 737-7865
Fax
(828) 737-7867
NPI assigned
Sep 13, 2006
Last updated
Jan 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Authorized official

Name
Teresa Elaine Barrier
Title
Director Patient Fin. Services
Phone
(828) 737-7011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X H0037 NC Primary

Addresses

Primary practice location

436 Hospital Dr, Sloop Medical Office Plaza
Suite 210
Linville, NC 28646

Mailing address

PO Box 459
Linville, NC 28646-0459
Phone (828) 737-7865

Other identifiers 4

IdentifierTypeStateIssuer
018G2OtherNCBC OF NC GRP PROV NUMBER
132NKOtherNCBC OF NC GRP PROV NUMBER
5902144MedicaidNC
89132NKMedicaidNC

Other names 1

  • Cannon Medical Associates Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000998 NC Part B Supplier - Clinic/Group Practice 3274426952 Receives reassigned benefits from 29 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Linville, NC

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1912002189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460459",
            "telephone_number": "828-737-7865",
            "fax_number": "828-737-7867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 HOSPITAL DR, SLOOP MEDICAL OFFICE PLAZA",
            "address_2": "SUITE 210",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "28646",
            "telephone_number": "828-737-7865",
            "fax_number": "828-737-7867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A. CANNON JR. MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "BARRIER",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "DIRECTOR PATIENT FIN. SERVICES",
        "authorized_official_telephone_number": "828-737-7011"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NC",
            "license": "H0037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF NC GRP PROV NUMBER",
            "identifier": "018G2",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF NC GRP PROV NUMBER",
            "identifier": "132NK",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902144",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89132NK",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cannon Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Linville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.