MR. KENNETH MICHAEL PETTIS JR. LMFT
NPI 1699485540
Marriage & Family Therapist in Lodi, CA
About Mr. Kenneth Michael Pettis Jr. Lmft NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. KENNETH MICHAEL PETTIS JR. LMFT (NPI 1699485540) is an individual marriage & family therapist in Lodi, California, licensed in California (150072) and active in the NPI registry since December 2022. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mr. Kenneth Michael Pettis Jr. Lmft is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kenneth Pettis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Stockton, CA 95207
- Reassigned Medicare billing, California enrollment
- 29 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.
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 Pettis's NPI number?
The NPI number for Kenneth Pettis is 1699485540. It was assigned to this individual provider in the NPPES registry on December 1, 2022.
Where is Kenneth Pettis located?
Kenneth Pettis practices at 315 W Pine St #3, 95240, Lodi, CA 95240. The listed phone number is (209) 366-2273.
What is Kenneth Pettis's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Kenneth Pettis enrolled in Medicare?
Yes. Kenneth Pettis is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kenneth Pettis's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Pettis reassigns Medicare benefits to An Elegant Sufficiency, A Psychological Corporation (Stockton, CA). The 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 Pettis'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 Pettis was last updated on October 15, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Mr. Kenneth Michael Pettis Jr., LMFT · NPI 1699485540
Marriage & Family Therapist provider in Lodi, California. Individual provider, active in the CMS NPPES registry since December 1, 2022.
## Identity
- **NPI:** 1699485540 (Entity type: Individual)
- **Enumerated:** December 1, 2022
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **State license:** 150072 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 315 W PINE ST #3, 95240, Lodi, CA 95240-4094
- **Phone:** (209) 366-2273
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** An Elegant Sufficiency, A Psychological Corporation (NPI 1427655810, Stockton, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 15, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1699485540) · Data from the CMS NPPES public registry.