CANNON MEMORIAL HOSPITAL — NPI 1861416216 (Licensed & Credentialed Allopathic & Osteopathic Physicians

CMS-1500 Box 24J / 33a • NPI

1861416216

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207Y00000X (CMS 04)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology

Box 32 Service Location & ZIP+4

123 WG ACKER DR, SUITE B, PICKENS, SC, 29671-2739

✓ 9-Digit EDI 837 ZIP+4 (29671-2739)

Practice Phone & Referral Fax

(864) 897-0390

Fax: (864) 653-7764

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1861416216 (CANNON MEMORIAL HOSPITAL) 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

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1861416216` (NPI-2 Organization / Facility)
Provider / Legal Name	CANNON MEMORIAL HOSPITAL
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology NUCC Code: `207Y00000X` (Otolaryngology)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	123 WG ACKER DR, SUITE B, PICKENS, SC, 29671-2739
Practice Telephone / Fax	Tel: (864) 897-0390 \| Fax: (864) 653-7764
Administrative Mailing Address	PO BOX 100174, COLUMBIA, SC, 29202-3174
Enumeration & Last Sync	Enumerated: 2006-07-27 \| CMS Record Updated: 2022-07-28
Authorized Official	MICHAEL CUNNINGHAM (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

123 WG ACKER DR, SUITE B, PICKENS, SC, 29671-2739

🗺️ Open in Google Maps 🏥 More Providers in PICKENS

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Plain-English Taxonomy & CMS Crosswalk (207Y00000X)

What Does Taxonomy Code 207Y00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207Y00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 04 (Physician/Otolaryngology)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Otolaryngology for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CANNON MEMORIAL HOSPITAL)

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
`207Y00000X` — Otolaryngology Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CANNON MEMORIAL HOSPITAL (NPI #1861416216)