BRADY CANNON – Anesthesiologist Assistant, NPI 1801265095

BRADY CANNON is a healthcare provider. based in Provo, Utah. specializing in ANESTHESIOLOGY ASSISTANT. They hold a License No. 2015033276 (MO). The NPI Number for BRADY CANNON is 1801265095

Main info

Male
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
BRADY CANNON
NPI
1801265095
Phone
(801) 888-1420
Address
4623 HILLSIDE DR
Enumeration Date
18 September 2015
Last Update Date
10 December 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8167817200
Graduation Year
2015 (11 years ago)
PAC ID
0941502348
Group Practice PAC ID
2365425865
Professional Enrollment ID
I20151231000390
Address ID
MO640689625LI2525XDRXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience44
Completeness75
Years active:10State licenses:1Digital endpointsOther names

357 ANESTHESIOLOGY ASSISTANT in MO

Provider Addresses for BRADY CANNON

  • 4623 HILLSIDE DR

    PROVO, UT 846045384

    Phone: (801) 888-1420

    Type: Mailing

  • 3801 S NATIONAL AVE

    SPRINGFIELD, MO 658075210

    Phone: (417) 269-6000

    Type: Location

  • PO BOX 804408

    KANSAS CITY, MO 641804408

    Phone: (913) 647-4100

    Fax: (913) 647-4120

    Type: Mailing

  • 2525 GLENN HENDREN DR

    LIBERTY, MO 640689625

    Phone: (816) 781-7200

    Fax: (816) 792-7196

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 3 Open Payments records for all available years, with a total value of $67.

Total Amount is formed as General ($67) + Research ($0) + Ownership ($0) = $67.

Last reported payment date: 2024-12-03 • Largest payer in this snapshot: VERTEX PHARMACEUTICALS INCORPORATED ($26).

Total Amount

$67

General + Research + Ownership

Payments

3

Total payment records

General Amount

$67

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-03

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2015-12-31

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
I20151231000390IAnesthesiology AssistantMOTBD

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84604)

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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: 2365425865View full group profile
NameSpecialtyState
A N E S T H E S I O L O G YMO
Anesthesiology AssistantMO
Anesthesiology AssistantMO
Certified Registered Nurse Anesthetist (Crna)FL
A N E S T H E S I O L O G YMO
Anesthesiology AssistantMO
Anesthesiology AssistantMO
Anesthesiology AssistantMO
-MO
-KS

Reviews

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Frequently asked questions

What NPI should I save for BRADY CANNON?
Save NPI 1801265095 if you need a stable reference for BRADY CANNON.
Is BRADY CANNON active in the national directory?
BRADY CANNON's public NPI profile is in an active state.
What field does BRADY CANNON work in?
You can think of BRADY CANNON as practicing within Anesthesiologist Assistant. Clinical services aligned with this taxonomy classification.
What location metadata exists for BRADY CANNON?
The page summarizes Provo, Utah for BRADY CANNON; expand the address list for detail.
Is BRADY CANNON a real provider?
This page reflects official NPPES data for NPI 1801265095. Always confirm identity and privileges with the practice and licensing boards.

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