DR. KENNETH PARKER JR. PHD
NPI 1417132275
Psychologist in San Jose, CA

Active since December 28, 2007PECOS EnrolledAccepts Medicare Assignment
441 PARK AVE, 2ND FLOOR, SAN JOSE, CA 95110(408) 287-2640(408) 287-7428 Get Directions Write a Review

NPPES record last updated: April 22, 2017. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Dr. Kenneth Parker Jr. Phd NPPES

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

DR. KENNETH PARKER JR. PHD (NPI 1417132275) is an individual psychologist in San Jose, California, licensed in California (PSY9141) and active in the NPI registry since December 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1981).

NPPES Registry Identity

NPI1417132275
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. KENNETH PARKER JR.Credential: PHD
Location Address441 PARK AVE, 2ND FLOORSan Jose, CA 95110-2615
Mailing AddressPo Box 6831San Jose, CA 95150-6831 · (408) 612-4935
Fax(408) 287-7428
Sole ProprietorNo
Medical School CMSOtherGraduated 1981
Enumeration DateDecember 28, 2007
Last NPPES UpdateApril 22, 2017
✔ NPI 1417132275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in CA · PSY9141
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
441 PARK AVE, San Jose, CA 95110

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

Dr. Kenneth Parker Jr. Phd 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 ID4981068608
PECOS Enrollment IDI20230914000940
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

2

Medicare enrollment records show Kenneth Parker reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Psychiatry
325 S 1ST ST STE 200
San Jose, CA 95113
  • Reassigned Medicare billing, California enrollment
  • 45 clinicians in this Medicare group
Addiction Medicine
4633 OLD IRONSIDES DR STE 304
Santa Clara, CA 95054
  • Reassigned Medicare billing, California enrollment
  • 1,607 clinicians in this Medicare group

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

Other Providers at the Same Location NPPES 7

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

Community/Behavioral Health
441 PARK AVE
SAN JOSE, CA 95110
Psychiatry & Neurology (Psychiatry)
441 PARK AVE
SAN JOSE, CA 95110
Psychologist (Clinical)
441 PARK AVE
SAN JOSE, CA 95110
Marriage & Family Therapist
441 PARK AVE
SAN JOSE, CA 95110
Social Worker (Clinical)
441 PARK AVE
SAN JOSE, CA 95110
Counselor (Mental Health)
441 PARK AVE
SAN JOSE, CA 95110
Social Worker
441 PARK AVE
SAN JOSE, CA 95110

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 Kenneth Parker's NPI number?

The NPI number for Kenneth Parker is 1417132275. It was assigned to this individual provider in the NPPES registry on December 28, 2007.

Where is Kenneth Parker located?

Kenneth Parker practices at 441 Park Ave 2nd Floor, San Jose, CA 95110. The listed phone number is (408) 287-2640.

What is Kenneth Parker's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Kenneth Parker enrolled in Medicare?

Yes. Kenneth Parker 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 Kenneth Parker's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Parker reassigns Medicare benefits to 2 organizations: Shine Medical Of Ca PC (San Jose, CA) and Sud Specialty Group - Ca (Santa Clara, 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 Kenneth Parker'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 Kenneth Parker was last updated on April 22, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.