SUSIE SHANTILA CANNON, traditional midwife — NPI 1487508024 (Licensed & Credentialed Midwife, Lay in TUPELO, MS)

CMS-1500 Box 24J / 33a • NPI

1487508024

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

175M00000X

Licensed & Credentialed Midwife, Lay

Box 32 Service Location & ZIP+4

1800 W MAIN ST, TUPELO, MS, 38801-3254

✓ 9-Digit EDI 837 ZIP+4 (38801-3254)

Practice Phone & Referral Fax

(504) 533-4716

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1487508024 (SUSIE SHANTILA CANNON, traditional midwife) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1487508024` (NPI-1 Individual Practitioner)
Provider / Legal Name	SUSIE SHANTILA CANNON, traditional midwife
Plain-English Specialty	Licensed & Credentialed Midwife, Lay NUCC Code: `175M00000X` (Midwife, Lay)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1800 W MAIN ST, TUPELO, MS, 38801-3254
Practice Telephone / Fax	Tel: (504) 533-4716
Administrative Mailing Address	184 LEWELLEN ST, WEST POINT, MS, 39773-2138
Enumeration & Last Sync	Enumerated: 2026-02-23 \| CMS Record Updated: 2026-02-23

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1800 W MAIN ST, TUPELO, MS, 38801-3254

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Plain-English Taxonomy & CMS Crosswalk (175M00000X)

What Does Taxonomy Code 175M00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 175M00000X translates to:
"Licensed & Credentialed Midwife, Lay"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Midwife, Lay for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SUSIE SHANTILA CANNON, traditional midwife)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`175M00000X` — Midwife, Lay Plain English: Licensed & Credentialed Midwife, Lay	State: MS \| License: `na` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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SUSIE SHANTILA CANNON, traditional midwife (NPI #1487508024)