Individual provider Active NPI

Roderick V. Dizon, M.D.

  • Neurology Physician
  • Owensboro, KY
National Provider Identifier
1689785495
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
TP433 Issued in KY
Practice address
1301 Pleasant Valley Rd
Suite 500C
Owensboro, KY 42303-9774
Phone
(270) 417-7830
Fax
(270) 417-7839
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301093864 MI
Neurology Physician 2084N0400X A96585 CA
Neurology Physician 2084N0400X MD60705551 WA
Neurology Physician 2084N0400X TP433 KY Primary

Addresses

Primary practice location

1301 Pleasant Valley Rd
Suite 500C
Owensboro, KY 42303-9774

Mailing address

PO Box 23229
Owensboro, KY 42304-3229
Phone (270) 688-1330

Other practice location 1

601 John St Ste M-124
Kalamazoo, MI 49007-5377
Phone (269) 341-7500

Other identifiers 1

IdentifierTypeStateIssuer
00A965850MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20101102000166 MI Practitioner - Neurology 9739270307 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

601 John St
Suite 124
Kalamazoo, MI 49007-5377
Phone (269) 341-7500

Hospital & facility affiliations

  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017

Merit-based Incentive Payment System (MIPS)

Final score
86.43 of 100Reported as group
Quality
75.38
Promoting interoperability
100
Improvement activities
40
Cost
79.38

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A96585CAMDNeurology Physician
4301093864MIMDNeurology Physician
MD60705551WAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Battle Creek Hospital Neurology CurrentSince Dec 1, 2023 Accepting new patients
Promed Healthcare CurrentSince Aug 7, 2011 Accepting new patients
Ascension Medical Group Promed Current Accepting new patients
Patholgy Services of Kalamazoo, PC Current Accepting new patients
Bronson Methodist Hospital Neurology CurrentSince Dec 1, 2023 Accepting new patients
Bronson Battle Creek Hospital CurrentSince Dec 1, 2023 Accepting new patients
Ascension Medical Group Promed CurrentSince Aug 7, 2011 Accepting new patients

Locations

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

1717 Shaffer St
Ste 002
Kalamazoo, MI 49048

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

1241 W Broadway St
Three Rivers, MI 49093
Phone (269) 273-9539

Interoperability endpoints

  • Direct secure messaging: direct@direct.bronsonhg.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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1689785495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23229",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423043229",
            "telephone_number": "270-688-1330",
            "fax_number": "270-688-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLEASANT VALLEY RD",
            "address_2": "SUITE 500C",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423039774",
            "telephone_number": "270-417-7830",
            "fax_number": "270-417-7839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 John St Ste M-124",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075377",
            "country_code": "US",
            "telephone_number": "269-341-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIZON",
        "first_name": "RODERICK",
        "middle_name": "V.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301093864",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A96585",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60705551",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "KY",
            "license": "TP433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A965850",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

Verify at the official NPI Registry.