Alvah Tyson Wickboldt Jr., M.D.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

305062 Issued in LA

Practice address

1514 Jefferson Hwy
Brent House Room 634
New Orleans, LA 70121-2429

Phone

(504) 842-3000

NPI assigned

Apr 15, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pain Management

Education

Louisiana State University School of Medicine in New Orleans, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Allied Health, LLCGroup PAC ID 8628453404, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Allied Health, LLC

  • Clinic/Center
  • Lake Charles, LA
  • NPI 1831611508
  Medicare reassignment Care Compare group NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • New Orleans, LA
  • NPI 1538151428
  Medicare reassignment NPD
• Ochsner Clinic LLC

  • Registered Dietitian
  • Covington, LA
  • NPI 1013747039
  NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • Raceland, LA
  • NPI 1699072041
  NPD
• Rosewood Rehabilitation, LLC

  • Physical Therapy Clinic/Center
  • Lafayette, LA
  • NPI 1528104882
  NPD (past)

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

{
    "created_epoch": "1334448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083971006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 JEFFERSON HIGHWAY",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701212429",
            "telephone_number": "504-842-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 JEFFERSON HWY",
            "address_2": "BRENT HOUSE ROOM 634",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701212429",
            "telephone_number": "504-842-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKBOLDT",
        "first_name": "ALVAH",
        "middle_name": "TYSON",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "LA",
            "license": "305062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whole Holmes Pediatrics
• Whole Life Solutions
• Wholeness Behavioral Health Sevices, LLC
• Katina Whorton
• Anna McGee Wibright
• Chantal Bich Phuong Wickman, MD
• Terrance Wickman
• Nimmi Nimesha Wickramasuriya, M.D.
• Christian Widdows, M.D.
• Kyle Emily Widmer, M.D.

• Pain Medicine Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Pain Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.