NPIMap

Individual provider Active NPI

Tak Ming Ko, MD

  • Surgery Physician
  • Palmer, AK
National Provider Identifier
1003995713
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
6953 Issued in AK
Practice address
2480 S Woodworth Loop Ste 180
Palmer, AK 99645-7408
Phone
(907) 373-8281
Fax
(855) 212-0736
NPI assigned
Nov 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 6953 AK Primary

Addresses

Primary practice location

2480 S Woodworth Loop Ste 180
Palmer, AK 99645-7408

Mailing address

2480 S Woodworth Loop
Ste 180
Palmer, AK 99645-7408
Phone (907) 373-8281

Other identifiers 1

IdentifierTypeStateIssuer
1019943MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, UT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100909000002 AK Practitioner - General SurgeryPractitioner - General Practice 5496780413
I20240411001259 UT Practitioner - General Surgery 5496780413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Washington School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Utah Medical GroupGroup PAC ID 2961496609, 52 clinicians
Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians

Practice addresses (Care Compare)

210 W 300
Roosevelt, UT 84066-2336
Phone (435) 722-4691

250 W 300
75 2
Roosevelt, UT 84066-2336
Phone (435) 722-4691

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.32 of 100Reported as apm
Quality
71.89
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy11
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6953AKMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Uintah Basin Medical Center CurrentSince Jan 17, 2024 Accepting new patients
Northeastern Utah Medical Group Surgery CurrentSince Jan 17, 2024 Accepting new patients
Northeastern Utah Medical Group Surgery CurrentSince Jan 17, 2024 Accepting new patients
Uintah Basin Medical Center CurrentSince Jan 17, 2024 Accepting new patients
Magic Valley Regional Medical Center Past Accepting new patients
Denali Surgical Specialists, LLC Surgery PastSince Jun 2, 2008 Accepting new patients
Susitna Surgery Center LLC PastSince Mar 31, 2018 Accepting new patients

Locations

50 E 200 S
Duchesne, UT 84021
Phone (435) 738-2426

210 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

250 W 300 N
Roosevelt, UT 84066
Phone (435) 722-4691

405 N 500 W
Vernal, UT 84078
Phone (435) 781-2335

Interoperability endpoints

  • Direct secure messaging: takmingko@tmkm-ak.direct.office.nextgen.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1003995713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 S WOODWORTH LOOP",
            "address_2": "STE 180",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457408",
            "telephone_number": "907-373-8281",
            "fax_number": "855-212-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 S WOODWORTH LOOP STE 180",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996457408",
            "telephone_number": "907-373-8281",
            "fax_number": "855-212-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KO",
        "first_name": "TAK MING",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AK",
            "license": "6953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019943",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmer, AK

Sources for this page

Verify at the official NPI Registry.