Kenneth Earl Ross, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R9C07 Issued in MO

Practice address

4 Ponder Executive PLZ
House Springs, MO 63051-3431

Phone

(636) 671-1563

Fax

(636) 671-3364

NPI assigned

Nov 29, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212019200000",
    "number": "1033286596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 PONDER EXECUTIVE PLZ",
            "city": "HOUSE SPRINGS",
            "state": "MO",
            "postal_code": "630513431",
            "telephone_number": "636-671-1563",
            "fax_number": "636-671-3364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 PONDER EXECUTIVE PLZ",
            "city": "HOUSE SPRINGS",
            "state": "MO",
            "postal_code": "630513431",
            "telephone_number": "636-671-1563",
            "fax_number": "636-671-3364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "KENNETH",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R9C07",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "241825306",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Robert Purdy Jr., RN
• Josephine Reale
• Rehab Missouri, LLC.
• Amanda Rideout
• Leon Romaine, O.D.
• Stacey Ann Roth, LPC
• Ryan W. Klohr, DMD, LLC
• Kristi Scanlon, M.S. CCC-SLP
• Susan Mary Self-Portwine, LCSW
• Kurtis Shoemake, MS, CCC-SLP

• Family Medicine Physician in House Springs, MO
• Providers in House Springs, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.