PAUL CANNON PA
NPI 1790212629
Physician Assistant - Surgical in Provo, UT

Q: What is Paul Cannon's NPI number?

The NPI number for Paul Cannon is 1790212629. It was assigned to this individual provider in the NPPES registry on May 23, 2017.

Q: What is Paul Cannon's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for Paul Cannon was last updated on August 16, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since May 23, 2017PECOS EnrolledAccepts Medicare Assignment

395 W COUGAR BLVD STE 503, PROVO, UT 84604(801) 442-3936 Get Directions Write a Review

NPPES record last updated: August 16, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 16, 2022, Oct 23, 2018, May 23, 2017 (3 updates tracked since 2017).

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About Paul Cannon Pa NPPES

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

PAUL CANNON PA (NPI 1790212629) is an individual surgical provider in Provo, Utah, licensed in Utah (12917809-1206) and active in the NPI registry since May 2017. He is enrolled in Medicare PECOS, is affiliated with Utah Valley Hospital, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1790212629

Entity TypeIndividualMale

Primary Taxonomy363AS0400X

Provider Legal NamePAUL CANNONCredential: PA

Location Address395 W COUGAR BLVD STE 503Provo, UT 84604-3323

Mailing Address395 W Cougar Blvd Ste 503Provo, UT 84604-3323 · (801) 442-3936

Phone(801) 442-3936

Sole ProprietorNo

Medical School CMSOtherGraduated 2017

Enumeration DateMay 23, 2017

Last NPPES UpdateAugust 16, 20223 updates tracked since enumeration

NPPES CertifiedAugust 16, 2022

✔ NPI 1790212629 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

License✔ Licensed in UT · 12917809-1206

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License PA.0005119 (CO)

395 W COUGAR BLVD STE 503, Provo, UT 84604

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Paul Cannon Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4587939046

PECOS Enrollment IDI20231212000656

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Harvest of vein using an endoscope 33508

Harvesting a vein using an endoscope is a procedure where a small camera is used to help surgeons remove a vein from your body. This vein is often used to bypass a blocked artery, improving blood flow to your heart.

29 services29 patients

Coronary artery bypass using vein or artery graft, 2 grafts 33518

A coronary artery bypass with 2 grafts is a surgery to improve blood flow to your heart. A surgeon takes a healthy vein or artery from your body and attaches it to the blocked coronary artery. This creates a new path for blood to flow, bypassing the blockage.

15 services15 patients

Harvest of artery from arm for heart bypass graft using an endoscope 33509

This procedure involves taking an artery from your arm using a small camera (endoscope). This artery is then used to bypass a blocked artery in your heart, improving blood flow and heart health. It's a common, safe procedure.

14 services14 patients

Coronary artery bypass using artery graft, 2 grafts 33534

A Coronary Artery Bypass with 2 grafts is a heart procedure. It involves taking healthy blood vessels from another part of your body and using them to bypass, or go around, blocked arteries in your heart. This helps improve blood flow to your heart.

14 services14 patients

Coronary artery bypass using artery graft, 1 graft 33533

A coronary artery bypass with one artery graft is a surgical procedure to improve blood flow to your heart. An artery from another part of your body is used to bypass a blocked or narrowed coronary artery. This can help reduce chest pain and risk of heart attack.

11 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Utah Valley Hospital

Acute Care Hospitals · Provo, UT

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number460001

Location1034 North 500 WestProvo, UT 84604 · Utah County

Emergency services Birthing friendly

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Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAMES SCOTT ARREGUI PA-C

Physician Assistant