Scott R Gillum, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA200106 Issued in LA

Practice address

7925 Youree Dr
Suite 200
Shreveport, LA 71105-5127

Phone

(318) 212-3610

Fax

(318) 212-3672

NPI assigned

Oct 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

WK Orthopedic ClinicGroup PAC ID 9436174489, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

Merit-based Incentive Payment System (MIPS)

Final score

91.53 of 100Reported as apm

Quality

81.42

Promoting interoperability

94.6

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

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

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.

• WK Orthopedic Clinic

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1780612119
  Medicare reassignment Care Compare group

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

• Willis Knighton Medical Center, Inc.

  dba WK Bossier Health Center

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  dba Willis Knighton South Hospital

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  dba WK Pierremont Health Center

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1114003076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7925 YOUREE DR",
            "address_2": "SUITE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055127",
            "telephone_number": "318-212-3610",
            "fax_number": "318-212-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 YOUREE DR",
            "address_2": "SUITE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055127",
            "telephone_number": "318-212-3610",
            "fax_number": "318-212-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "SCOTT",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "PA200106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristen Gilliam
• Rebecca Gilliam
• Shamora Shaw'Nae Gilliam, MHS
• Shelby Gilliam
• Paris Gillum
• Teresa Diane Wilson Gillyard
• John M Gilmer Jr., D.D.S.
• Shawn Gilmore
• Timothy W Gilmore, R.T.
• Tyler Gilmore, MD

• Surgical Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Surgical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; 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.