WK Pediatric Intensivist

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

Legal business name

WK PEDIATRIC INTENSIVIST

Practice address

2510 Bert Koun Loop RM 4003
Shreveport, LA 71118-3119

Phone

(318) 212-5665

Fax

(318) 212-5698

NPI assigned

Apr 24, 2006

Organization subpart

No

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

Authorized official

Name

Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-3868

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Craig Chu, M.D.

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1164740262

  LA

  Medicare reassignment NPD
• Shannon Renee Faulkinberry, MD, MPH

  • Pediatric Critical Care Medicine Physician
  • Shreveport, LA
  • NPI 1104246545

  LA, Pediatric Critical Care Medicine

  Medicare reassignment NPD
• Minh Q Tran, M.D.

  • Pediatric Critical Care Medicine Physician
  • Shreveport, LA
  • NPI 1194059386

  LA, Pediatric Critical Care Medicine

  Medicare reassignment NPD
• Giao N DO, M.D.

  • Pediatric Critical Care Medicine Physician
  • Shreveport, LA
  • NPI 1992792535

  Pediatric Critical Care Medicine

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525824000000",
    "number": "1023074549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 BERT KOUN LOOP RM 4003",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183119",
            "telephone_number": "318-212-5665",
            "fax_number": "318-212-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 BERT KOUN LOOP RM 4003",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183119",
            "telephone_number": "318-212-5665",
            "fax_number": "318-212-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK PEDIATRIC INTENSIVIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2018-05-09",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-3868"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1099091",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Orthopedic Specialty Center
• WK Pediatric Eye Specialists
• WK Pediatric Gi Specialists
• WK Pediatric Health & Wellness
• WK Pediatric Healthcare Associates
• WK Pediatric Pulmonology Specialists
• WK Pediatric Surgical Associates
• WK Pelvic & Reconstructive Surgery
• WK Physicians Network
• WK Pierre Ave Community Health Education and Wellness Center

• All providers in Shreveport, LA
• Pediatric Critical Care Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.