SOO H KO AGNP
NPI 1114673092
Nurse Practitioner - Gerontology in East Boston, MA
About Soo H Ko Agnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOO H KO AGNP (NPI 1114673092) is an individual gerontology provider in East Boston, Massachusetts, licensed in Massachusetts (RN2326883) and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Soo H Ko Agnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
2Medicare enrollment records show Soo Ko reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
East Boston, MA 02128
- Reassigned Medicare billing, Massachusetts enrollment
- Medicare enrollment name: East Boston Neighborhood Health Center Corp
- 456 clinicians in this Medicare group
East Boston, MA 02128
- Reassigned Medicare billing, Massachusetts enrollment
- 577 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 02128 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Soo Ko's NPI number?
The NPI number for Soo Ko is 1114673092. It was assigned to this individual provider in the NPPES registry on March 1, 2022.
Where is Soo Ko located?
Soo Ko practices at 10 Gove St, East Boston, MA 02128. The listed phone number is (617) 569-5899.
What is Soo Ko's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Soo Ko enrolled in Medicare?
Yes. Soo Ko is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Soo Ko's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Soo Ko reassigns Medicare benefits to 2 organizations: Neighborhealth Corporation (East Boston, MA) and Internal Medical Associates-Ebnhc (East Boston, MA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Soo Ko's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Soo Ko was last updated on January 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Soo H Ko, AGNP · NPI 1114673092
Gerontology physician in East Boston, Massachusetts. Individual provider, active in the CMS NPPES registry since March 1, 2022.
## Identity
- **NPI:** 1114673092 (Entity type: Individual)
- **Enumerated:** March 1, 2022
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **State license:** RN2326883 (Massachusetts)
- **Sole proprietor:** No
## Practice location
- **Address:** 10 GOVE ST, East Boston, MA 02128-1931
- **Phone:** (617) 569-5899
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Neighborhealth Corporation (NPI 1316994411, East Boston, MA); Internal Medical Associates-Ebnhc (NPI 1558481879, East Boston, MA) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 19, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1114673092) · Data from the CMS NPPES public registry.