Individual provider Active NPI

William M Ko, MD

  • Pain Medicine (Anesthesiology) Physician
  • Fullerton, CA
National Provider Identifier
1629011762
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
A82916 Issued in CA
Practice address
100 E Valencia Mesa Dr
Suite 310
Fullerton, CA 92835-3813
Phone
(714) 446-5200
Fax
(714) 446-5292
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A82916 CA
Pain Medicine (Anesthesiology) Physician 207LP2900X A82916 CA Primary

Addresses

Primary practice location

100 E Valencia Mesa Dr
Suite 310
Fullerton, CA 92835-3813

Mailing address

100 E Valencia Mesa Dr Ste 310
Fullerton, CA 92835-3800
Phone (714) 446-5200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wko1372649@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20061219000259 CA Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 5092714162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
University of Southern California Keck School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3816
Phone (714) 871-3006

1514 Valley Vista Dr
Diamond Bar, CA 91765-3929
Phone (909) 860-1144

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Dec 30, 2010 Accepting new patients
Providence Medical Foundation CurrentSince Dec 30, 2010 Accepting new patients
Providence Medical Foundation Current Accepting new patients
St Jude Hospital Inc Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1514 Valley Vista Dr
Diamond Bar, CA 91765
Phone (909) 560-1144

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

100 E Valencia Mesa Dr
Ste 310
Fullerton, CA 92835
Phone (714) 446-5200

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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 2

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1629011762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR STE 310",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353800",
            "telephone_number": "714-446-5200",
            "fax_number": "714-449-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E VALENCIA MESA DR",
            "address_2": "SUITE 310",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353813",
            "telephone_number": "714-446-5200",
            "fax_number": "714-446-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KO",
        "first_name": "WILLIAM",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A82916",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A82916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wko1372649@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "100 E Valencia Mesa Dr",
            "address_2": "Suite 310",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928353813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.