Individual provider Active NPI

Rodney D Tyson Sr., M.D.

  • Family Medicine Physician
  • Tifton, GA
National Provider Identifier
1962598458
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
038994 Issued in GA
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 382-7120
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 038994 GA Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

907 18TH St E
Suite 150
Tifton, GA 31794-3643
Phone (229) 353-3422

Other identifiers 3

IdentifierTypeStateIssuer
00703425AMedicaidGA
58-2255001OtherGATAX ID
507222OtherGABCBS PROVIDER NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rodney.tyson@trhs.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20051017000072 GA Practitioner - Family Practice 0840216222 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
038994GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System Inc CurrentSince Aug 1, 2019 Accepting new patients
Tift Regional Health System Inc Family Medicine Current Accepting new patients
Tift Regional Health System Inc CurrentSince Aug 1, 2019 Accepting new patients
Tift Regional Health System Inc CurrentSince Jul 3, 2011 Accepting new patients
BCH Medical Investors, LLC Past Accepting new patients

Locations

103 James St
Adel, GA 31620
Phone (229) 245-0666

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

1221 E McPherson Ave
Nashville, GA 31639
Phone (229) 543-7100

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

907 18th St E
Ste 150
Tifton, GA 31794
Phone (229) 353-3422

907 18th St E
Ste 400
Tifton, GA 31794

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

Interoperability endpoints

  • Direct secure messaging: rodney.tyson@trhs.cernerdirect.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1962598458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E",
            "address_2": "SUITE 150",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943643",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "RODNEY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "038994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00703425A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "58-2255001",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "507222",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rodney.tyson@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "901 18th St E",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317943648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.