Individual provider Active NPI

Gin Sou Ngo, PT

  • Physical Therapist
  • Saint Louis, MO
National Provider Identifier
1083344329
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2023009642 Issued in MO
Practice address
4444 Forest Park Ave
Ste 1210
Saint Louis, MO 63108-2212
Phone
(314) 286-1940
Fax
(314) 286-1473
NPI assigned
Jun 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2023009642 MO Primary

Addresses

Primary practice location

4444 Forest Park Ave
Ste 1210
Saint Louis, MO 63108-2212

Mailing address

PO Box 60352
Saint Louis, MO 63160-0352
Phone (314) 286-1940

Other identifiers 1

IdentifierTypeStateIssuer
480128523MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230920002939 MO Practitioner - Physical Therapist in Private Practice 2860871712 Reassigns benefits to 1 organization
I20250331000125 IL Practitioner - Physical Therapist in Private Practice 2860871712 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
May accept Medicare assignment
Group practices
Northwest Wellness Group LLCGroup PAC ID 8921324716, 7 clinicians

Practice addresses (Care Compare)

1614 W Central Rd
Suite 200
Arlington Heights, IL 60005-2453
Phone (847) 481-6077

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Wellness Group LLC CurrentSince Mar 1, 2025 Accepting new patients
Washington University Physical Therapist CurrentSince Sep 1, 2023 Accepting new patients
Washington University CurrentSince Sep 1, 2023 Accepting new patients

Locations

1614 W Central Rd
Ste 200
Arlington Hts, IL 60005
Phone (847) 481-6077

4444 Forest Park Ave
Ste 1210
Saint Louis, MO 63108

4444 Forest Park Ave
#8502
Saint Louis, MO 63108
Phone (314) 286-1430

660 S Euclid Ave
Saint Louis, MO 63110

4444 Forest Park Ave
Ste 1101
Saint Louis, MO 63108
Phone (314) 286-1440

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22368/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1083344329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60352",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631600352",
            "telephone_number": "314-286-1940",
            "fax_number": "314-286-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4444 FOREST PARK AVE",
            "address_2": "STE 1210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082212",
            "telephone_number": "314-286-1940",
            "fax_number": "314-286-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGO",
        "first_name": "GIN",
        "middle_name": "SOU",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-10",
        "last_updated": "2024-04-25",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2023009642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "480128523",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4444 Forest Park Ave",
            "address_2": "Ste 1210",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.