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DIANE KO D.M.D.
NPI 1205245685
Dentist in Perryville, MO

Active since August 11, 2014Opted out of Medicare · through Feb 1, 2028
1314 BRENDA AVE, PERRYVILLE, MO 63775(573) 517-0405(573) 517-0420 Get Directions Write a Review

NPPES record last updated: August 18, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Diane Ko D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIANE KO D.M.D. (NPI 1205245685) is an individual dentist in Perryville, Missouri, licensed in Missouri (2014027291) and active in the NPI registry since August 2014. She has opted out of Medicare through February 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1205245685
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameDIANE KOCredential: D.M.D.
Location Address1314 BRENDA AVEPerryville, MO 63775-2303
Mailing Address408 S Broadview StCape Girardeau, MO 63703-5725 · (573) 332-0808 · Fax (573) 339-7945
Phone(573) 517-0405
Fax(573) 517-0420
Sole ProprietorNo
Enumeration DateAugust 11, 2014
Last NPPES UpdateAugust 18, 2015
✔ NPI 1205245685 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MO · 2014027291
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
1314 BRENDA AVE, Perryville, MO 63775
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Diane Ko D.m.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from February 1, 2016 through February 1, 2028.

Opt-Out Effective DateFebruary 1, 2016
Opt-Out In Effect ThroughFebruary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63775 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.64 typical visit price
range $52.28 – $161.24
Typical copayment $20.41 (range $13.07 – $40.31)
Most-billed visit code 99203
Established Patient
$65.71 typical visit price
range $16.30 – $131.05
Typical copayment $16.42 (range $4.07 – $32.76)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CROSS TRAILS MEDICAL CENTER
Clinic/Center (Federally Qualified Health Center (FQHC))
1314 BRENDA AVE
PERRYVILLE, MO 63775
Perry County (573) 332-0808
JULIA L ABERNATHY RDH
Dental Hygienist
1314 BRENDA AVE
PERRYVILLE, MO 63775
Perry County (573) 517-0405
ANGELA KAY WRIGHT APRN, FNP-BC
Nurse Practitioner (Family)
1314 BRENDA AVE
PERRYVILLE, MO 63775
Perry County (573) 517-0405
CROSS TRAILS MEDICAL CENTER
Dentist (General Practice)
1314 BRENDA AVE
PERRYVILLE, MO 63775
Perry County (573) 332-0808

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 Diane Ko's NPI number?

The NPI number for Diane Ko is 1205245685. It was assigned to this individual provider in the NPPES registry on August 11, 2014.

Where is Diane Ko located?

Diane Ko practices at 1314 Brenda Ave, Perryville, MO 63775. The listed phone number is (573) 517-0405.

What is Diane Ko's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Diane Ko enrolled in Medicare?

No. Diane Ko has opted out of Medicare through February 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Diane Ko was last updated on August 18, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.