Samuel Harrison Cannon Jr, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Lake Geneva, WI

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Samuel Harrison Cannon Jr, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Lake Geneva, Wisconsin. He graduated from nursing school in 2012 and has 14 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Aurora Medical Group, Inc. and his current practice location is N2950 State Road 67, Lake Geneva, Wisconsin. You can reach out to his office (for appointments etc.) via phone at (262) 245-0535.

Samuel Harrison Cannon Jr is licensed to practice in Illinois (license number 041353866) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1831432996.

Contact Information

Samuel Harrison Cannon Jr, CRNA
N2950 State Road 67,
Lake Geneva, WI 53147-2655
(262) 245-0535
Not Available

Map and Direction




Provider's Profile

Full NameSamuel Harrison Cannon Jr
GenderMale
SpecialityCertified Registered Nurse Anesthetist (crna)
Experience14 Years
LocationN2950 State Road 67, Lake Geneva, Wisconsin
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Samuel Harrison Cannon Jr graduated from nursing school in 2012
  NPI Data:
  • NPI Number: 1831432996
  • Provider Enumeration Date: 03/27/2013
  • Last Update Date: 04/10/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 1658508593
  • Enrollment ID: I20150209001093

Medical Identifiers

Medical identifiers for Samuel Harrison Cannon Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1831432996NPI-NPPES
100042105MedicaidWI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered 041353866 (Illinois)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Aurora Medical Center KenoshaKenosha, WIHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Aurora Medical Group, Inc.67097942583491

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samuel Harrison Cannon Jr allows following entities to bill medicare on his behalf.
Entity NameAurora Medical Group, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427271378
PECOS PAC ID: 6709794258
Enrollment ID: O20031105000725
Entity NameMercy Health System Corporation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1598718603
PECOS PAC ID: 7416860440
Enrollment ID: O20031113000164
Entity NameStateline Anesthesiologists Sc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1316937519
PECOS PAC ID: 1355353822
Enrollment ID: O20060627000180
Entity NameBrookfield Anesthesiologists Sc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1942257902
PECOS PAC ID: 5395847529
Enrollment ID: O20070219000542
Entity NameAnesthesia Partners Services Sc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1861810947
PECOS PAC ID: 4082832514
Enrollment ID: O20140826000757
Entity NamePolykarpos Anesthesia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1154850972
PECOS PAC ID: 9436424629
Enrollment ID: O20171016000281

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samuel Harrison Cannon Jr is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Samuel Harrison Cannon Jr, CRNA
29624 Network Pl,
Chicago, IL 60673-1296

Ph: (608) 756-6278		Samuel Harrison Cannon Jr, CRNA
N2950 State Road 67,
Lake Geneva, WI 53147-2655

Ph: (262) 245-0535

Reviews and Comments


Nurse Anesthetist, Certified Registered Nurses in Lake Geneva, WI

Mark R. Dvorak, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: N2950 State Road 67, Lake Geneva, WI 53147
Phone: 262-245-4990    Fax: 262-245-2248

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.