NPIMap

Organization Active NPI

Charles a Cannon Jr Memorial Hospital Inc

Doing business as Pulmonology Inpatient

  • Pulmonary Disease Physician
  • Linville, NC
National Provider Identifier
1952976003
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
CHARLES A CANNON JR MEMORIAL HOSPITAL INC
Doing business as
Pulmonology Inpatient
Practice address
434 Hospital Dr
Linville, NC 28646
Phone
(828) 262-4133
Fax
(828) 262-4103
NPI assigned
May 21, 2021
Last updated
Jan 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CHARLES A CANNON JR MEMORIAL HOSPITAL INC.As reported in NPPES

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
Mary Etta Long
Title
SVP Medical Staff Relations
Phone
(828) 262-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

434 Hospital Dr
Linville, NC 28646

Mailing address

434 Hospital Dr
Linville, NC 28646
Phone (828) 262-4133

Other names 1

  • Pulmonology Inpatient 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
O20140813002123 NC Part B Supplier - Clinic/Group Practice 3274426952 Receives reassigned benefits from 61 practitioners
2 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 2

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

National Provider Directory

National Provider Directory
Tax ID family
Baldwin Emerg Physicians14 organizations share this tax ID, including this one
Part of
Baldwin Emerg Physicians

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 1

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.

  • Garret Duron
    • Internal Medicine Physician
    • Birmingham, AL
    • NPI 1053894774
    NPD

NPI Registry JSON

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1952976003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 HOSPITAL DR",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "28646",
            "telephone_number": "828-262-4133",
            "fax_number": "828-262-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 HOSPITAL DR",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "28646",
            "telephone_number": "828-262-4133",
            "fax_number": "828-262-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A CANNON JR MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES A CANNON JR MEMORIAL HOSPITAL INC.",
        "enumeration_date": "2021-05-21",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ETTA",
        "authorized_official_title_or_position": "SVP MEDICAL STAFF RELATIONS",
        "authorized_official_telephone_number": "828-262-4133"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": "Pulmonology Inpatient",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pulmonology Inpatient",
            "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.