MYLES JULIAN KETCHUM M.D., PH.D.
NPI 1093249864
Family Medicine - Addiction Medicine in Santa Rosa, CA

Q: What is Myles Ketchum's NPI number?

The NPI number for Myles Ketchum is 1093249864. It was assigned to this individual provider in the NPPES registry on April 18, 2017.

Q: What is Myles Ketchum's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Addiction Medicine, with taxonomy code 207QA0401X.

Q: When was this NPI record last updated?

The NPPES record for Myles Ketchum was last updated on May 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.

Active since April 18, 2017PECOS EnrolledAccepts Medicare Assignment

2360 MENDOCINO AVE, SANTA ROSA, CA 95403(707) 573-5250(707) 573-5458 Get Directions Write a Review

NPPES record last updated: May 27, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 27, 2025, Jun 30, 2020, Apr 18, 2017 (3 updates tracked since 2017).

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About Myles Julian Ketchum M.d., Ph.d. NPPES

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

MYLES JULIAN KETCHUM M.D., PH.D. (NPI 1093249864) is an individual addiction medicine provider in Santa Rosa, California, licensed in California (1211497) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS and is a graduate of Louisiana State University School Of Medicine In New Orleans (2017).

NPPES Registry Identity

NPI1093249864

Entity TypeIndividualMale

Primary Taxonomy207QA0401X

Provider Legal NameMYLES JULIAN KETCHUMCredential: M.D., PH.D.

Location Address2360 MENDOCINO AVESanta Rosa, CA 95403-3153

Mailing AddressPo Box 276950Sacramento, CA 95827-6950 · (707) 573-5250 · Fax (707) 573-5458

Phone(707) 573-5250

Fax(707) 573-5458

Sole ProprietorYes

Medical School CMSLouisiana State University School Of Medicine In New OrleansGraduated 2017

Enumeration DateApril 18, 2017

Last NPPES UpdateMay 27, 20253 updates tracked since enumeration

NPPES CertifiedMay 27, 2025

✔ NPI 1093249864 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily Medicine · Addiction MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0401X

License✔ Licensed in CA · 1211497

Definition

A family medicine physician who specializes in the diagnosis and treatment of addictions.

Also ListedPreventive Medicine · Addiction MedicineTaxonomy 2083A0300X · License 61-25999 (CA)

2360 MENDOCINO AVE, Santa Rosa, CA 95403

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Myles Julian Ketchum M.d., Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1052664307

PECOS Enrollment IDI20200908000789

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.

Medicare Billing Reassignments

Medicare enrollment records show Myles Ketchum reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Santa Rosa Community Health Centers

1.2 mi

Federally Qualified Health Center (FQHC)

1300 N DUTTON AVE
Santa Rosa, CA 95401

Reassigned Medicare billing, California enrollment
215 clinicians in this Medicare group

NPI 1780195255 (707) 303-3600

Sutter Bay Medical Foundation

50 mi

Multi-Specialty

12 CAMINO ENCINAS
Orinda, CA 94563

Reassigned Medicare billing, California enrollment
4,479 clinicians in this Medicare group

NPI 1366898538 (510) 204-8180

Dignity Health

119 mi

Multi-Specialty

2340 LIBERTY PKWY STE 200
Red Bluff, CA 96080

Reassigned Medicare billing, California enrollment
131 clinicians in this Medicare group

NPI 1134687734 (530) 529-7760

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

95 services75 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

20 services20 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95403 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

$142.00 typical visit price

range $63.04 – $187.01

Typical copayment $35.50 (range $15.76 – $46.75)

Most-billed visit code 99204

Established Patient

$109.88 typical visit price

range $21.02 – $153.40

Typical copayment $27.47 (range $5.25 – $38.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 10

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

15 suppliers41 claims89 services$3.09 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

10 suppliers21 claims27 services$0.48 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier23 claims23 services$15.20 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

3 suppliers44 claims44 services$5.66 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

3 suppliers39 claims39 services$86.24 avg. paid by Medicare

Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg J7613

DME-Drugs Administered Through DME · category DG006N

7 suppliers38 claims5,734 services$0.03 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

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

SANTA ROSA DENTAL

Dentist (General Practice)

2360 MENDOCINO AVE, SUITE A 6
SANTA ROSA, CA 95403

Sonoma County (707) 568-1436

MR. EUGENE G FIELD D.D.S

Dentist

2360 MENDOCINO AVE, SUIT A-6
SANTA-ROSA, CA 95403

Sonoma County (707) 568-1436

JP MEDICAL SOLUTIONS, LLC

Durable Medical Equipment & Medical Supplies

2360 MENDOCINO AVE, A2-205
SANTA ROSA, CA 95403

Sonoma County (707) 202-4542

VALARIE BOCHENEK NP

Registered Nurse (Emergency)

2360 MENDOCINO AVE
SANTA ROSA, CA 95403

Sonoma County (800) 972-5547

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 Myles Ketchum's NPI number?

The NPI number for Myles Ketchum is 1093249864. It was assigned to this individual provider in the NPPES registry on April 18, 2017.

Where is Myles Ketchum located?

Myles Ketchum practices at 2360 Mendocino Ave, Santa Rosa, CA 95403. The listed phone number is (707) 573-5250.

What is Myles Ketchum's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Addiction Medicine, with taxonomy code 207QA0401X.

Is Myles Ketchum enrolled in Medicare?

Yes. Myles Ketchum is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Myles Ketchum's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Myles Ketchum reassigns Medicare benefits to 3 organizations: Santa Rosa Community Health Centers (Santa Rosa, CA), Sutter Bay Medical Foundation (Orinda, CA) and Dignity Health (Red Bluff, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Myles Ketchum's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Myles Ketchum was last updated on May 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.