SAMUEL HARRISON CANNON JR. CRNA
NPI 1831432996
Nurse Anesthetist, Certified Registered in Lake Geneva, WI
About Samuel Harrison Cannon Jr. Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL HARRISON CANNON JR. CRNA (NPI 1831432996) is an individual nurse anesthetist, certified registered in Lake Geneva, Wisconsin, licensed in Illinois (041353866) and active in the NPI registry since March 2013. He is enrolled in Medicare PECOS, is affiliated with Aurora Medical Center Kenosha, and maintains a secondary practice location in Zion.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Samuel Harrison Cannon Jr. Crna 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.
Medicare Billing Reassignments
5Medicare enrollment records show Samuel Cannon reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Lake Geneva, WI 53147
- Reassigned Medicare billing, Wisconsin enrollment
- Also billed through NPI 1598718603 (Wisconsin)
- 271 clinicians in this Medicare group
Beloit, WI 53511
- Reassigned Medicare billing, Wisconsin enrollment
- 28 clinicians in this Medicare group
Pleasant Prairie, WI 53158
- Reassigned Medicare billing, Wisconsin enrollment
- 16 clinicians in this Medicare group
Brookfield, WI 53045
- Reassigned Medicare billing, Wisconsin enrollment
- Medicare enrollment name: Brookfield Anesthesiologists Sc
- 31 clinicians in this Medicare group
West Allis, WI 53227
- Reassigned Medicare billing, Wisconsin enrollment
- 4,609 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 3
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.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Aurora Medical Center Kenosha
Acute Care Hospitals · Kenosha, WIMercy Walworth Hospital & Medical Center
Critical Access Hospitals · Lake Geneva, WIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 53147 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Reported Quality Measures
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Samuel Cannon's NPI number?
The NPI number for Samuel Cannon is 1831432996. It was assigned to this individual provider in the NPPES registry on March 27, 2013.
Where is Samuel Cannon located?
Samuel Cannon practices at N2950 State Road 67, Lake Geneva, WI 53147. The listed phone number is (262) 245-0535.
What is Samuel Cannon's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Samuel Cannon enrolled in Medicare?
Yes. Samuel Cannon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Samuel Cannon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Cannon reassigns Medicare benefits to 5 organizations: Mercy Health System Corporation (Lake Geneva, WI), Stateline Anesthesiologists Sc (Beloit, WI), Polykarpos Anesthesia LLC (Pleasant Prairie, WI), Brookfield Anesthesiologists, S.C. (Brookfield, WI) and Aurora Medical Group, Inc. (West Allis, WI). Each 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 Samuel Cannon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samuel Cannon accept?
Health plans from CareSource (Common Ground Healthcare) list Samuel Cannon 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.
Is Samuel Cannon affiliated with any hospitals?
According to CMS data, Samuel Cannon is affiliated with Aurora Medical Center Kenosha and Mercy Walworth Hospital & Medical Center.
When was this NPI record last updated?
The NPPES record for Samuel Cannon was last updated on October 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 days 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.
# Samuel Harrison Cannon Jr., CRNA · NPI 1831432996
Nurse Anesthetist, Certified Registered physician in Lake Geneva, Wisconsin. Individual provider, active in the CMS NPPES registry since March 27, 2013.
## Identity
- **NPI:** 1831432996 (Entity type: Individual)
- **Enumerated:** March 27, 2013
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 041353866 (Illinois)
- **Sole proprietor:** Yes
## Practice location
- **Address:** N2950 STATE ROAD 67, Lake Geneva, WI 53147-2655
- **Phone:** (262) 245-0535
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging
- **Bills Medicare through:** 5 organizations under Medicare reassignment (form CMS-855R): Mercy Health System Corporation (NPI 1699728550, Lake Geneva, WI); Stateline Anesthesiologists Sc (NPI 1316937519, Beloit, WI); Polykarpos Anesthesia LLC (NPI 1154850972, Pleasant Prairie, WI); Brookfield Anesthesiologists, S.C. (NPI 1942257902, Brookfield, WI); Aurora Medical Group, Inc. (NPI 1457592735, West Allis, WI) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2012
## Record status
- **NPPES last updated:** October 16, 2026
- **Other identifiers:** Medicaid 100042105 (WI)
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Source: [NPI Profile](https://npiprofile.com/npi/1831432996) · Data from the CMS NPPES public registry.