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ROBERT M CANNON MD LLC
NPI 1174067250
Clinic/Center - Primary Care in Vicksburg, MS

Active since December 08, 2016
1901 MISSION 66, VICKSBURG, MS 39180(601) 636-0097(601) 629-9969 Get Directions Write a Review

NPPES record last updated: December 8, 2016. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Robert M Cannon Md Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROBERT M CANNON MD LLC (NPI 1174067250) is a healthcare organization registered as a primary care in Vicksburg, Mississippi and active in the NPI registry since December 2016. The organization lists Robert Cannon, Md, as its authorized official.

NPPES Registry Identity

NPI1174067250
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameROBERT M CANNON MD LLC
Location Address1901 MISSION 66Vicksburg, MS 39180-3711
Mailing Address1901 Mission 66Vicksburg, MS 39180-3711 · (601) 636-0097 · Fax (601) 629-9969
Phone(601) 636-0097
Fax(601) 629-9969
Organization SubpartNo
Authorized OfficialRobert CannonMd · (601) 636-0097
Enumeration DateDecember 8, 2016
✔ NPI 1174067250 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
1901 MISSION 66, Vicksburg, MS 39180
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Robert M Cannon Md Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Robert M Cannon MD LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Robert Cannon, M.D.
Family Practice
NPI 1215373139
1901 MISSION 66
Vicksburg, MS 39180
(601) 636-0097
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Robert M Cannon MD LLC's NPI number?

The NPI number for Robert M Cannon MD LLC is 1174067250. It was assigned to this organization in the NPPES registry on December 8, 2016.

Where is Robert M Cannon MD LLC located?

Robert M Cannon MD LLC is located at 1901 Mission 66, Vicksburg, MS 39180. The listed phone number is (601) 636-0097.

What is Robert M Cannon MD LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Is Robert M Cannon MD LLC enrolled in Medicare?

Yes. Robert M Cannon MD LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Robert M Cannon MD LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Robert M Cannon MD LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Robert M Cannon MD LLC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Robert M Cannon MD LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Robert M Cannon MD LLC was last updated on December 8, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.