Dr Su Min Ko, MD is a medicare enrolled "Pain Medicine - Interventional Pain Medicine" physician in Fairfax, Virginia. He graduated from medical school in 1996 and has 28 years of diverse experience with area of expertise as Interventional Pain Management. His current practice location is
11166 Fairfax Blvd, Suite 105, Fairfax, Virginia. You can reach out to his office (for appointments etc.) via phone at
(703) 277-3360.
Dr Su Min Ko is licensed to practice in Virginia (license number 0101250991) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1336375450.
Physician's Profile
| Full Name | Dr Su Min Ko |
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| Gender | Male |
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| Speciality | Interventional Pain Management |
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| Experience | 28 Years |
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| Location | 11166 Fairfax Blvd, Fairfax, Virginia |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Su Min Ko graduated from medical school in 1996
NPI Data:
- NPI Number: 1336375450
- Provider Enumeration Date: 06/03/2009
- Last Update Date: 02/20/2017
Medicare PECOS Information:
- PECOS PAC ID: 3678627916
- Enrollment ID: I20121203000017
Medical Identifiers
Medical identifiers for Dr Su Min Ko such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1336375450 | NPI | - | NPPES |
| 9496409 | Other | MO | AETNA |
| 98246 | Other | MO | HCUSA |
| 2009001606 | Other | MO | MEDICAL LICENSE |
| 000000640716 | Other | MO | BCBS |
| 1336375450 | Medicaid | MO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 0101250991 (Virginia) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | 2009001606 (Missouri) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 2009001606 (Missouri) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 0101250991 (Virginia) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Su Min Ko allows following entities to bill medicare on his behalf.
| Entity Name | Better Life Pain Clinic, Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1659792323
PECOS PAC ID: 8426200296
Enrollment ID: O20121203000013 |
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| Entity Name | Virginia Integrative Health Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1568809713
PECOS PAC ID: 9830324391
Enrollment ID: O20131108001653 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Su Min Ko is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Su Min Ko, MD
11166 Fairfax Blvd, Suite 105,
Fairfax, VA 22030-5017
Ph: (703) 277-3360 | Dr Su Min Ko, MD
11166 Fairfax Blvd, Suite 105,
Fairfax, VA 22030-5017
Ph: (703) 277-3360 |
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