HOMER GARY KETCHERSIDE D.D.S.,M.S.
NPI 1043570658
Dentist - Orthodontics and Dentofacial Orthopedics in Corona, CA

Active since May 17, 2012PECOS Enrolled
720 MAGNOLIA AVE, SUITE A1, CORONA, CA 92879(951) 737-3800(951) 737-3937 Get Directions Write a Review

NPPES record last updated: July 22, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Homer Gary Ketcherside D.d.s.,m.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HOMER GARY KETCHERSIDE D.D.S.,M.S. (NPI 1043570658) is an individual orthodontics and dentofacial orthopedics provider in Corona, California, licensed in California (28872) and active in the NPI registry since May 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043570658
Entity TypeIndividualMale
Primary Taxonomy1223X0400X
Provider Legal NameHOMER GARY KETCHERSIDECredential: D.D.S.,M.S.
Location Address720 MAGNOLIA AVE, SUITE A1Corona, CA 92879-3119
Mailing Address720 Magnolia Ave, Suite A1Corona, CA 92879-3119 · (951) 737-3802 · Fax (951) 737-3937
Fax(951) 737-3937
Sole ProprietorYes
Enumeration DateMay 17, 2012
Last NPPES UpdateJuly 22, 2013
NPI 1043570658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
License Licensed in CA · 28872
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
720 MAGNOLIA AVE, Corona, CA 92879

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Homer Gary Ketcherside D.d.s.,m.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92879 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$74.08 typical visit price
range $19.37 – $146.42
Typical copayment $18.52 (range $4.84 – $36.60)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Massage Therapist
720 MAGNOLIA AVE
CORONA, CA 92879
Ophthalmology
720 MAGNOLIA AVE, SUITE A-4
CORONA, CA 92879
Dentist
720 MAGNOLIA AVE, SUITE C1
CORONA, CA 92879
Dentist
720 MAGNOLIA AVE, BLDG. C1
CORONA, CA 92879
Dentist (General Practice)
720 MAGNOLIA AVE, SUITE A3
CORONA, CA 92879
Acupuncturist
720 MAGNOLIA AVE, #B3
CORONA, CA 92879

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Homer Ketcherside's NPI number?

The NPI number for Homer Ketcherside is 1043570658. It was assigned to this individual provider in the NPPES registry on May 17, 2012.

Where is Homer Ketcherside located?

Homer Ketcherside practices at 720 Magnolia Ave Suite A1, Corona, CA 92879. The listed phone number is (951) 737-3800.

What is Homer Ketcherside's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

Is Homer Ketcherside enrolled in Medicare?

Yes. Homer Ketcherside is registered in the Medicare PECOS enrollment system.

What insurance does Homer Ketcherside accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Homer Ketcherside as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Homer Ketcherside was last updated on July 22, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.