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DR. KENNETH FREDERICK PROSSER III M.D.
NPI 1770694598
Pediatrics in Santa Rosa, CA

Active since August 31, 2006PECOS Enrolled
500 DOYLE PARK DR, SUITE 100, SANTA ROSA, CA 95405(707) 544-6090(707) 544-2389 Get Directions Write a Review

NPPES record last updated: November 9, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 9, 2021, Feb 4, 2021 (2 updates tracked since 2021).

About Dr. Kenneth Frederick Prosser Iii M.d. NPPES

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

DR. KENNETH FREDERICK PROSSER III M.D. (NPI 1770694598) is an individual pediatrics provider in Santa Rosa, California, licensed in California (G70988) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1770694598
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. KENNETH FREDERICK PROSSER IIICredential: M.D.
Location Address500 DOYLE PARK DR, SUITE 100Santa Rosa, CA 95405-4558
Mailing Address500 Doyle Park Dr, Suite 100Santa Rosa, CA 95405-4558 · (707) 544-6090 · Fax (707) 544-2389
Phone(707) 544-6090
Fax(707) 544-2389
Sole ProprietorNo
Enumeration DateAugust 31, 2006
Last NPPES UpdateNovember 9, 20212 updates tracked since enumeration
NPPES CertifiedNovember 9, 2021
✔ NPI 1770694598 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · G70988
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
500 DOYLE PARK DR, Santa Rosa, CA 95405
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kenneth Frederick Prosser Iii M.d. 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 95405 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
$96.16 typical visit price
range $63.04 – $187.01
Typical copayment $24.04 (range $15.76 – $46.75)
Most-billed visit code 99203
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.

Other Providers at the Same Location NPPES 20

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

LEO ARTHUR SMITH MD
Family Medicine
500 DOYLE PARK DR, SUITE G-04
SANTA ROSA, CA 95405
Sonoma County (707) 303-8360
CYNTHIA R. INGELS MSN,N.P.
Nurse Practitioner (Family)
500 DOYLE PARK DR, SUITE 103
SANTA ROSA, CA 95405
Sonoma County (707) 579-1102
DR. JAMES CHARLES DEVORE MD
Family Medicine
500 DOYLE PARK DR, SUITE G04
SANTA ROSA, CA 95405
Sonoma County (707) 303-8360
DR. TOMAS VASILIAUSKAS M.D.
Internal Medicine (Cardiovascular Disease)
500 DOYLE PARK DR, SUITE G05
SANTA ROSA, CA 95405
Sonoma County (707) 576-7100
ERAN MATALON M.D.
Internal Medicine
500 DOYLE PARK DR, SUITE 304
SANTA ROSA, CA 95405
Sonoma County (707) 545-1700
RAMZI KHALIL DEEIK M.D.
Thoracic Surgery (Cardiothoracic Vascular Surgery)
500 DOYLE PARK DR, SUITE G-05
SANTA ROSA, CA 95405
Sonoma County (707) 255-8825
DR. JOEL E PAINE MD
Internal Medicine
500 DOYLE PARK DR, SUITE 300
SANTA ROSA, CA 95405
Sonoma County (707) 303-8344
ANNADEL MEDICAL GROUP, INC
Pediatrics
500 DOYLE PARK DR, SUITE 100
SANTA ROSA, CA 95405
Sonoma County (707) 544-6090

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 Prosser's NPI number?

The NPI number for Kenneth Prosser is 1770694598. It was assigned to this individual provider in the NPPES registry on August 31, 2006.

Where is Kenneth Prosser located?

Kenneth Prosser practices at 500 Doyle Park Dr Suite 100, Santa Rosa, CA 95405. The listed phone number is (707) 544-6090.

What is Kenneth Prosser's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Kenneth Prosser enrolled in Medicare?

Yes. Kenneth Prosser is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kenneth Prosser was last updated on November 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.