Active NPI
Rodney D Tyson Sr., M.D.
- Family Medicine Physician
- Tifton, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 038994
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00703425A | Medicaid | GA | |
| 58-2255001 | Other | GA | TAX ID |
| 507222 | Other | GA | BCBS PROVIDER NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 038994 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tift Regional Health System Inc | Current | Accepting new patients | |
| Tift Regional Health System Inc | Family Medicine | Current | Accepting new patients |
| Tift Regional Health System Inc | Current | Accepting new patients | |
| Tift Regional Health System Inc | Current | 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
- 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.
-
- Family Medicine Physician
- Tifton, GA
- NPI 1881203305
Family Medicine, GA
-
- Clinic/Center
- Tifton, GA
- NPI 1003980996
-
- Internal Medicine Physician
- Tifton, GA
- NPI 1326271669
-
- Ophthalmology Physician
- Tifton, GA
- NPI 1790280857
-
- General Acute Care Hospital
- Nashville, GA
- NPI 1952557407
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.