Su Min Ko, M.D.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

0101250991 Issued in VA

Practice address

11166 Fairfax Blvd
Suite 105
Fairfax, VA 22030-5017

Phone

(703) 277-3360

Fax

(703) 277-3370

NPI assigned

Jun 3, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physical Medicine and Rehabilitation

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.17 of 100Reported as individual

Quality

75.41

Improvement activities

40

Cost

76.68

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: suminko@blpc-va.direct.office.nextgen.com

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.

• Better Life Pain Clinic, PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Annandale, VA
  • NPI 1659792323

  DC

  Medicare reassignment NPD Authorized official
• Better Life Pain Clinic, PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Ellicott City, MD
  • NPI 1548681638
  Medicare reassignment NPD Authorized official
• Auto Injury Rehab Center, LLC

  • Chiropractor
  • Annandale, VA
  • NPI 1518474626
  NPD Authorized official
• Better Life Pain Clinic, PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Fairfax, VA
  • NPI 1306109590
  NPD Authorized official
• Hyattsville Rehab Center, LLC

  • Pain Clinic/Center
  • Adelphi, MD
  • NPI 1639733348
  NPD Authorized official
• Abdul Naushad MD PC

  • Pain Medicine Physician
  • Poplar Bluff, MO
  • NPI 1306839196
  NPD (past)

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

{
    "created_epoch": "1243987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1336375450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11166 FAIRFAX BLVD",
            "address_2": "SUITE 105",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305017",
            "telephone_number": "703-277-3360",
            "fax_number": "703-277-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11166 FAIRFAX BLVD",
            "address_2": "SUITE 105",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305017",
            "telephone_number": "703-277-3360",
            "fax_number": "703-277-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KO",
        "first_name": "SU MIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-03",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "VA",
            "license": "0101250991",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2009001606",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MO",
            "license": "2009001606",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "VA",
            "license": "0101250991",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9496409",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCUSA",
            "identifier": "98246",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "2009001606",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000640716",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336375450",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Knowles, LPC
• Molly Knudsen
• Elizabeth A J Knudson, LPC
• Sydney Paige Knupp
• Ahra Ko, LSA
• Tammy Ko, M.ED, BCBA
• Laura Strehle Kobler, MS, NP
• Thomas Paul Kobylski, MD
• Jill Kocanyar, LPC
• Anthony Koch, PSYD, LCP, LPC, NCC

• Interventional Pain Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Interventional Pain Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.