MR. RANDALL CLAY CANNON (PT) – Orthopedic Physical Therapist, NPI 1790136836

MR. RANDALL CLAY CANNON (PT) is a healthcare provider. based in Macon, Georgia. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. PT011885 (GA). The NPI Number for MR. RANDALL CLAY CANNON (PT) is 1790136836

Main info

Male
11 Years Of Experience
Accepts Medicare Assignment
Name
MR. RANDALL CLAY CANNON (PT)
NPI
1790136836
Phone
(478) 745-4206
Address
3708 NORTHSIDE DR
Enumeration Date
30 June 2016
Last Update Date
25 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4783531166
Graduation Year
2015 (11 years ago)
PAC ID
7113212630
Group Practice PAC ID
1355254780
Professional Enrollment ID
I20160823002467
Address ID
GA310212561DU100XXDRXX303
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness85
Years active:9State licenses:1Digital endpointsOther names

2,871 PHYSICAL THERAPIST IN PRIVATE PRACTICE in GA

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Provider Addresses for MR. RANDALL CLAY CANNON (PT)

  • 3708, Northside Drive, McKibben Lane, Macon, Bibb County, Georgia, 31210, United States

    MACON, GA 312102404

    Phone: (478) 745-4206

    Fax: (478) 254-5463

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-08-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160823002467IPhysical Therapist In Private PracticeGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes2,885233$0
97530Therapy procedure using functional activities51462$0
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care49292$0
97161Evaluation for physical therapy, typically 20 minutes226203$0
97140Therapy procedure using manual technique, each 15 minutes16039$0
View full utilization report →

Insurance plans in this area (ZIP 31210)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1355254780View full group profile
NameSpecialtyState
-GA
-AL
Physical Therapist In Private PracticeGA
Physician AssistantAL
Physical Therapist In Private PracticeGA
Sports Medicine, Orthopedic Surgery, Orthopedic SurgeryGA
Nurse PractitionerGA
Physical Therapist In Private PracticeSC
Sports Medicine, Orthopedic SurgeryGA
Occupational Therapist In Private PracticeGA

Reviews

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Frequently asked questions

How do payers reference MR. RANDALL CLAY CANNON (PT)?
For MR. RANDALL CLAY CANNON (PT), use NPI 1790136836 as the unique 10-digit identifier.
Active or inactive — what applies to MR. RANDALL CLAY CANNON (PT)?
You should see MR. RANDALL CLAY CANNON (PT) as active in CMS-hosted NPPES data.
What area of care is associated with MR. RANDALL CLAY CANNON (PT)?
MR. RANDALL CLAY CANNON (PT)'s record emphasizes Orthopedic Physical Therapist. Clinical services aligned with this taxonomy classification.
What practice footprint exists for MR. RANDALL CLAY CANNON (PT)?
Travel planning: use Macon, Georgia as the reference point for MR. RANDALL CLAY CANNON (PT), then confirm.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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