Kenneth M Soda

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A72328 Issued in CA

Practice address

235 S Palisade Dr
Santa Maria, CA 93454

Phone

(805) 739-3561

NPI assigned

Feb 27, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ksoda85278@santaclaravalley.direct-ci.net

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.

• County of Santa Clara

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1629301346
  Medicare reassignment NPD
• County of Santa Clara

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Jose, CA
  • NPI 1699885079
  Medicare reassignment NPD
• County of Santa Clara

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1972598449
  NPD
• Dap Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Borrego Springs, CA
  • NPI 1134144165

  Family Medicine

  NPD
• Pacific Central Coast Health Centers

  • Community Health Clinic/Center
  • Bakersfield, CA
  • NPI 1720752355
  NPD (past)

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1447387477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 E MAIN ST STE 201",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S PALISADE DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "93454",
            "telephone_number": "805-739-3561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8510 Bryant St",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Westminster",
            "state": "CO",
            "postal_code": "800313844",
            "country_code": "US",
            "telephone_number": "303-430-6015",
            "fax_number": "303-430-6001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SODA",
        "first_name": "KENNETH",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A72328",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "39948",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76434354",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Mark Smith
• Smooth, Inc.
• Inglyand Snell-Anderson
• Social Advocates for Youth - Santa Maria, Inc.
• Social Advocates for Youth - Santa Maria, Inc.
• Elizabeth Soderlund
• Sojourn Services Inc
• Aira Solis
• Violeta Chavez Solis
• Gabriel Anthony Solla, LCSW

• Family Medicine Physician in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.

Verify at the official NPI Registry.