Kyong Yol Ko, M.D.
Individual provider Active NPI Family Medicine Physician · Chaparral, NM
NPI 1720083322 · NPPES record last updated Dec 19, 2013
Key facts
- NPI
- 1720083322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2003-0543 (NM)
- Practice address
- 545 S. County Line Dr.
Space a
Chaparral, NM 88081-7809 - Phone
- (505) 824-5007
- Fax
- (505) 824-0322
- NPI assigned
- Jun 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
545 S County Line Dr
A
Chaparral, NM 88081-7802
Phone (575) 824-5007
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040615001780 | NM | Practitioner - Family Practice | 0840274064 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County Line Medical Service Inc | Family Medicine | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2003-0543 | NM | Yes |
Addresses
Primary practice location
545 S. County Line Dr.
Space a
Chaparral, NM 88081-7809
Mailing address
101 Green Pasture CT
Anthony, NM 88021
Phone (505) 824-5007
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40725391 | Medicaid | NM |
Other providers in Chaparral, NM
- Mahmood R Hurab
- Ruby Ibarra
- Kemp Inc.
- Jessica Kinsey
- Rebecca Jane Knowles
- La Clinica de Familia, Incorporated
- La Clinica de Familia, Incorporated
- La Clinica de Familia, Incorporated
- La Clinica de Familia, Incorporated
- La Clinica de Familia, Incorporated
All providers in Chaparral, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.