Active NPI
Kelvin C Wade, M.D.
- Internal Medicine Physician
- Monroe, LA
National Provider Identifier
1043334089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 11502R
- Practice address
- 401 Hall St Ste a
Monroe, LA 71201-7528 - Phone
- (318) 324-9113
- Fax
- (318) 329-9382
- NPI assigned
- Mar 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 11502R | LA | Primary |
Addresses
Primary practice location
401 Hall St Ste a
Monroe, LA 71201-7528
Mailing address
401 Hall St Ste a
Monroe, LA 71201-7528
Phone (318) 324-9113
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1664782 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100929000074 | LA | Practitioner - Internal Medicine | 5799801692 | Practice locations: Monroe, LA |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Cincinnati College of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
401 Hall St a
Monroe, LA 71201-7528
Phone (318) 324-9113
Hospital & facility affiliations
- Best Home Health
- Haven Home Health Inc
- Acg Hospice
- Fmol Health St Francis
- Glenwood Regional Medical Center
- Morehouse General Hospital
- Specialty Hospital
- Mary Goss Nursing Home
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11502R | LA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Monroe Surgical Hospital, LLC | Past | Accepting new patients | |
| Hope Hospice, LLC | Past | Accepting new patients | |
| Mary Goss Nursing Home, Inc | Past | Accepting new patients | |
| St Francis Medical Center, Inc | Past | Accepting new patients |
Interoperability endpoints
- kwade16275@direct.casso.us.com
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community Based Hospice Care Agency
- Jonesboro, LA
- NPI 1386796944
-
- Skilled Nursing Facility
- Monroe, LA
- NPI 1609861780
-
- Rural Health Clinic/Center
- Mangham, LA
- NPI 1871153379
-
- General Acute Care Hospital
- Monroe, LA
- NPI 1295723229
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Columbia, LA
- NPI 1689659484
-
- Community Based Hospice Care Agency
- Jonesboro, LA
- NPI 1386796944
-
- General Acute Care Hospital
- West Monroe, LA
- NPI 1548083421
-
- General Acute Care Hospital
- Bastrop, LA
- NPI 1003898313
-
- Long Term Care Hospital
- Monroe, LA
- NPI 1528385382
Long-term care hospital
-
- General Acute Care Hospital
- Monroe, LA
- NPI 1295723229
-
- Home Health Agency
- Monroe, LA
- NPI 1003862384
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278028800000",
"number": "1043334089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 HALL ST STE A",
"city": "MONROE",
"state": "LA",
"postal_code": "712017528",
"telephone_number": "318-324-9113",
"fax_number": "318-329-9382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 HALL ST STE A",
"city": "MONROE",
"state": "LA",
"postal_code": "712017528",
"telephone_number": "318-324-9113",
"fax_number": "318-329-9382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "KELVIN",
"middle_name": "C",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2010-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "LA",
"license": "11502R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1664782",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.