Individual provider Active NPI

Gary Dean Williams, MD

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1093747297
Registry record updated Dec 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
06590R Issued in LA
Practice address
2520 Bert Kouns Industrial Loop
Suite 202
Shreveport, LA 71118-3130
Phone
(318) 212-5040
Fax
(318) 212-5045
NPI assigned
Jul 7, 2006
Last updated
Dec 21, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 06590R LA Primary

Addresses

Primary practice location

2520 Bert Kouns Industrial Loop
Suite 202
Shreveport, LA 71118-3130

Mailing address

2520 Bert Kouns Industrial Loop
Suite 202
Shreveport, LA 71118-3130
Phone (318) 212-5040

Other identifiers 1

IdentifierTypeStateIssuer
1339482MedicaidLA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071227000128 LA Practitioner - Internal Medicine 0547350829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Missouri, Kansas City, School of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2520 Bert Koun Loop
Suite 202
Shreveport, LA 71118-3130
Phone (318) 212-5040

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
WK Pierremont Hospitalists CurrentSince Jul 1, 2022 Accepting new patients
Gary Williams MD and Willis-Knighton Medical Center Internal Medicine CurrentSince Jan 1, 2007 Accepting new patients

Locations

1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946

2520 Bert Kouns Industrial Loop
Ste 202
Shreveport, LA 71118
Phone (318) 212-5040

8001 Youree Dr
Ste 4007
Shreveport, LA 71115
Phone (318) 212-3821

8001 Youree Dr
Ste 880
Shreveport, LA 71115
Phone (318) 212-3908

Interoperability endpoints

  • Direct secure messaging: gwilliam1@direct.wkhs.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198195200000",
    "number": "1093747297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183130",
            "telephone_number": "318-212-5040",
            "fax_number": "318-212-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183130",
            "telephone_number": "318-212-5040",
            "fax_number": "318-212-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "GARY",
        "middle_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "06590R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1339482",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.