NPIMap

Individual provider Active NPI

Kenny David Rodriguez, MD

  • Otolaryngology Physician
  • Waterloo, IA
National Provider Identifier
1447783139
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD-49631 Issued in IA
Practice address
2515 Cyclone Dr Ste B
Waterloo, IA 50701-9746
Phone
(319) 888-8044
NPI assigned
Apr 10, 2017
Last updated
Jul 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD-49631 IA Primary

Addresses

Primary practice location

2515 Cyclone Dr Ste B
Waterloo, IA 50701-9746

Mailing address

PO Box 2758
Waterloo, IA 50704-2758
Phone (319) 235-5390

Other practice location 1

13001 E 17th Pl
University of Colorado GME
Aurora, CO 80045-2570
Phone (303) 724-1965

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220509000933 IA Practitioner - Otolaryngology 1254600778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Colorado School of Medicine, Aurora, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2515 Cyclone Dr
Suite B
Waterloo, IA 50701-9715
Phone (319) 833-5970

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision163
Removal of skin lesions1-10
Removal or shaving of skin growth27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD-49631IAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Cedar Valley Medical Specialists PC Otolaryngology CurrentSince Jul 1, 2022 Accepting new patients
Cedar Valley Medical Specialists PC CurrentSince Jul 1, 2022 Accepting new patients
Cedar Valley Medical Specialists PC Past Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

201 E J Ave
Grundy Center, IA 50638
Phone (319) 824-5081

1560 Boyson Rd
Ste D
Hiawatha, IA 52233
Phone (319) 888-8044

1600 1st St E
Independence, IA 50644
Phone (319) 332-0999

1753 W Ridgeway Ave
Ste 107
Waterloo, IA 50701
Phone (319) 833-5907

2515 Cyclone Dr
Ste B
Waterloo, IA 50701
Phone (319) 833-5970

4150 Kimball Ave
Waterloo, IA 50701
Phone (319) 235-5390

Interoperability endpoints

  • Direct secure messaging: kenny.rodriguez@cvms.eclinicaldirectplus.com
  • Direct secure messaging: krodriguez3936141@direct.trinity-health.org
  • Direct secure messaging: krodriguez893668@direct.unitypoint.org

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1447783139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2758",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042758",
            "telephone_number": "319-235-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 CYCLONE DR STE B",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507019746",
            "telephone_number": "319-888-8044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13001 E 17th Pl",
            "address_2": "University of Colorado GME",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452570",
            "country_code": "US",
            "telephone_number": "303-724-1965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KENNY",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IA",
            "license": "MD-49631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.