Individual provider Active NPI

Van B Ho

  • Nurse Practitioner
  • Bridgeton, MO
National Provider Identifier
1144844309
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2019014169 Issued in MO
Practice address
12774 Boenker LN
Bridgeton, MO 63044-2436
Phone
(314) 291-7997
Fax
(314) 739-1471
NPI assigned
Jun 3, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2019014169 MO Primary

Addresses

Primary practice location

12774 Boenker LN
Bridgeton, MO 63044-2436

Mailing address

PO Box 776874
Chicago, IL 60677-6874
Phone (314) 291-7997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201117001794 MO Practitioner - Nurse Practitioner 5597176883 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pai Participant 1 LLCGroup PAC ID 8123351954, 174 clinicians
Generation Clinical Partners LLCGroup PAC ID 1557687803, 24 clinicians

Practice addresses (Care Compare)

1650 High St
Washington, MO 63090-4365
Phone (636) 390-3290

505 Couch Ave
Kirkwood, MO 63122-5577
Phone (314) 822-9911

575 Couch Ave
Kirkwood, MO 63122-5536
Phone (314) 925-0903

723 S Laclede Station Rd
Webster Groves, MO 63119-4911
Phone (314) 968-5570

Hospital & facility affiliations

  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191
  • Christian Hospital Northeast Hospital, Saint Louis, MO, CCN 260180
  • SSM Health Depaul Hospital St Louis Hospital, Bridgeton, MO, CCN 260104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Infectious Disease Services LLC CurrentSince Sep 1, 2023 Accepting new patients

Locations

12774 Boenker Ln
Bridgeton, MO 63044
Phone (314) 291-7997

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.

Hospital & facility affiliations 5

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": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1144844309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776874",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776874",
            "telephone_number": "314-291-7997",
            "fax_number": "314-739-1471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12774 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442436",
            "telephone_number": "314-291-7997",
            "fax_number": "314-739-1471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HO",
        "first_name": "VAN",
        "middle_name": "B",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2024-06-25",
        "certification_date": "2021-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2019014169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.