Kenneth Dizon, DO

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

4682 Issued in AZ

Practice address

5859 W Talavi Blvd
Ste 100
Glendale, AZ 85306-1870

Phone

(602) 298-7777

Fax

(623) 930-6060

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

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

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Phoenix Heart PLLCGroup PAC ID 7113906421, shared by 2 NPIs, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Thunderbird Medical Center Hospital, Glendale, AZ, CCN 030089
• Banner Estrella Medical Center Hospital, Phoenix, AZ, CCN 030115
• Abrazo Arrowhead Hospital Hospital, Glendale, AZ, CCN 030094

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdizon@yourcarecommunity.org
• Direct secure messaging: kenneth.dizon.1@24502.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/24502/brand/1/csg/1/fhir/r4

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

• Hospital Development of West Phoenix Inc

  • Cardiovascular Disease Physician
  • Goodyear, AZ
  • NPI 1013100692
  Medicare reassignment NPD
• Phoenix Heart, PLLC

  • Cardiac Rehabilitation Registered Nurse
  • Glendale, AZ
  • NPI 1578396982
  Medicare reassignment NPD
• Phoenix Heart, PLLC

  • Cardiovascular Disease Physician
  • Glendale, AZ
  • NPI 1679608095
  Medicare reassignment NPD
• North Phoenix Heart Center

  • Cardiovascular Disease Physician
  • Phoenix, AZ
  • NPI 1043241979
  NPD (past)
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141

  Internal Medicine

  NPD (past)
• VHS of Arrowhead Inc

  • Cardiovascular Disease Physician
  • Glendale, AZ
  • NPI 1326231903
  NPD (past)
• Millennium Medical Group West PC

  • Family Medicine Physician
  • Westland, MI
  • NPI 1447352075

  Internal Medicine

  NPD (past)
• Ravindra Gautam, M.D., Inc.

  • Internal Medicine Physician
  • Barstow, CA
  • NPI 1366490310
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Banner Estrella Medical Center

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1275566200
  Care Compare affiliation
• Banner Thunderbird Medical Center

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1154355188
  Care Compare affiliation
• VHS of Arrowhead, Inc

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1326022765
  Care Compare affiliation
• VHS of Arrowhead, Inc.

  • General Acute Care Hospital
  • Peoria, AZ
  • NPI 1801340781
  Care Compare affiliation

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1346252129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5859 W TALAVI BLVD STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061870",
            "telephone_number": "602-298-7777",
            "fax_number": "623-930-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5859 W TALAVI BLVD",
            "address_2": "STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853061870",
            "telephone_number": "602-298-7777",
            "fax_number": "623-930-6060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 S 7th Ave",
            "address_purpose": "LOCATION",
            "city": "Barstow",
            "state": "CA",
            "postal_code": "923113058",
            "country_code": "US",
            "telephone_number": "760-256-1004 x306",
            "fax_number": "760-256-1055",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "930 W Main St",
            "address_purpose": "LOCATION",
            "city": "Barstow",
            "state": "CA",
            "postal_code": "923112654",
            "country_code": "US",
            "telephone_number": "760-256-1004 x306",
            "fax_number": "760-256-1055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIZON",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "4682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "239042",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmunhall@phoenixheart.com",
            "affiliation": "Y",
            "endpointDescription": "Credentialing Coordinator",
            "affiliationName": "Phoenix Heart, PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5859 W TALAVI BLVD",
            "address_2": "SUITE 100",
            "city": "Glendale",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "853061870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Divine Grace LLC
• Divine Hospice and Palliative Care LLC
• Brittany Marie Divito, NP
• Marissa Danielle Divito
• Victoria Friedman Dixon, DMD
• Nasser Djavadi, MD
• DME Supply Place Inc.
• Phuong Anh Thi DO
• Bao Thuy Thi Doan, MD
• William G Dobbin, PHARM.D

• Cardiovascular Disease Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Cardiovascular Disease Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.