Kenneth Robert Diddie, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G033939 Issued in CA

Practice address

1220 La Venta Dr
Suite 211
Westlake Village, CA 91361-3703

Phone

(805) 379-0200

Fax

(805) 496-5204

NPI assigned

Mar 24, 2006

Last updated

Mar 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Chicago, Pritzker School of Medicine, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Retinal Consultants of Southern California Medical Group, Inc

  • Specialist
  • Westlake Village, CA
  • NPI 1700807815
  Medicare reassignment NPD Authorized official
• Providence Saint John's Health Center

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1124026273
  NPD (past)
• Tarzana Medical Center LLC

  dba Providence Cedars-Sinai Tarzana Medical Center

  • General Acute Care Hospital
  • Tarzana, CA
  • NPI 1821250762
  NPD (past)
• West Hills Hospital

  dba West Hills Hospital & Medical Center

  • General Acute Care Hospital
  • West Hills, CA
  • NPI 1023065729
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1184684219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 LA VENTA DR",
            "address_2": "SUITE 211",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913613703",
            "telephone_number": "805-379-0200",
            "fax_number": "805-496-5204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 LA VENTA DR",
            "address_2": "SUITE 211",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913613703",
            "telephone_number": "805-379-0200",
            "fax_number": "805-496-5204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIDDIE",
        "first_name": "KENNETH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G033939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G339391",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Weiss, L.Ac
• Antonio Alberto Diaz Cooper, NP
• Antonio Diaz Sanchez
• Susan Diballa, D.C.
• Leah L. Dickenson, PH.D.
• Diehl Chiropractic, Inc. (Maximized Life Chiropractic)
• David Diehl, D.C.
• Holly Dilger
• Tishanna Dillard
• Mary Susan Dillon Tschudi, LMFT

• Specialist in Westlake Village, CA
• Providers in Westlake Village, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.