NPIMap

Individual provider Active NPI

Kenneth George Ross, M.D.

  • Family Medicine Physician
  • Texarkana, AR
National Provider Identifier
1265752810
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E-14975 Issued in AR
Practice address
3417 U of a Way
Texarkana, AR 71854-1419
Phone
(870) 779-6000
Fax
(870) 779-6055
NPI assigned
Jun 6, 2010
Last updated
Jul 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A124793 CA
Family Medicine Physician 207Q00000X E-14975 AR Primary

Addresses

Primary practice location

3417 U of a Way
Texarkana, AR 71854-1419

Mailing address

PO Box 251420
Little Rock, AR 72225-1420
Phone (501) 686-8000

Other practice location 1

1550 W Manchester Ave
Los Angeles, CA 90047-5424
Phone (800) 954-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140313000540 CA Practitioner - Family Practice 7416187455 Reassigns benefits to 1 organization
I20220810000401 TX Practitioner - Family Practice 7416187455

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Napa Valley Family Medical Group IncGroup PAC ID 9234184102, 7 clinicians

Practice addresses (Care Compare)

1001 Professional Dr
Napa, CA 94558-6413
Phone (707) 252-0494

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions22
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-14975ARMDFamily Medicine Physician
A124793CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
University of Arkansas for Medical Sciences Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Napa Valley Family Medical Group, Inc Family Medicine CurrentSince Jul 12, 2023 Accepting new patients

Locations

4301 W Markham St
#783
Little Rock, AR 72205
Phone (501) 603-1278

300 E 6th St
Texarkana, AR 71854
Phone (870) 779-6000

3417 U of a Way
Texarkana, AR 71854
Phone (870) 779-6000

1001 Professional Dr
Napa, CA 94558
Phone (707) 252-0494

1222 Pine St
Saint Helena, CA 94574
Phone (707) 963-2711

1000 Pine St
Texarkana, TX 75501
Phone (903) 798-7365

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72471
  • Direct secure messaging: kenneth.ross.1@30147.direct.athenahealth.com

Organizations & group practices 3

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 8

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": "1275782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1265752810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 251420",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251420",
            "telephone_number": "501-686-8000",
            "fax_number": "501-526-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 U OF A WAY",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541419",
            "telephone_number": "870-779-6000",
            "fax_number": "870-779-6055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 W Manchester Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900475424",
            "country_code": "US",
            "telephone_number": "800-954-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSS",
        "first_name": "KENNETH",
        "middle_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-06",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A124793",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-14975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, AR

Sources for this page

Verify at the official NPI Registry.