CANON PROFESSIONAL WELLNESS CLINIC LLC
NPI 1780384560
Nurse Practitioner - Primary Care in Canon City, CO
About Canon Professional Wellness Clinic Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CANON PROFESSIONAL WELLNESS CLINIC LLC (NPI 1780384560) is a healthcare organization registered as a primary care in Canon City, Colorado and active in the NPI registry since March 2023. The organization lists Leslie Nelson, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Canon Professional Wellness Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Canon Professional Wellness Clinic LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
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 Canon Professional Wellness Clinic LLC's NPI number?
The NPI number for Canon Professional Wellness Clinic LLC is 1780384560. It was assigned to this organization in the NPPES registry on March 9, 2023.
Where is Canon Professional Wellness Clinic LLC located?
Canon Professional Wellness Clinic LLC is located at 730 Macon Ave, Canon City, CO 81212. The listed phone number is (719) 275-1618.
What is Canon Professional Wellness Clinic LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Canon Professional Wellness Clinic LLC enrolled in Medicare?
Yes. Canon Professional Wellness Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Canon Professional Wellness Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Canon Professional Wellness Clinic 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. Of these, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Canon Professional Wellness Clinic LLC was last updated on February 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Canon Professional Wellness Clinic Llc · NPI 1780384560
Primary Care organization in Canon City, Colorado. Organization record, active in the CMS NPPES registry since March 9, 2023.
## Identity
- **NPI:** 1780384560 (Entity type: Organization)
- **Enumerated:** March 9, 2023
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Organization subpart:** No
- **Authorized official:** Leslie Nelson, OWNER
## Practice location
- **Address:** 730 MACON AVE, Canon City, CO 81212-3314
- **Phone:** (719) 275-1618
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 19, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1780384560) · Data from the CMS NPPES public registry.