Individual provider Active NPI

William A. Wesche, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Shreveport, LA
National Provider Identifier
1174511653
Registry record updated Feb 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
15162R Issued in LA
Practice address
2915 Missouri Ave
Shreveport, LA 71109-4327
Phone
(318) 364-2000
NPI assigned
Oct 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 15162R LA Primary

Addresses

Primary practice location

2915 Missouri Ave
Shreveport, LA 71109-4327

Mailing address

PO Box 3780
Tupelo, MS 38803-3780

Other identifiers 2

IdentifierTypeStateIssuer
11302019OtherCAQH
1161446MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, TX, AR3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20050715000089 LA Practitioner - Pathology 7517900889 Reassigns benefits to 1 organization
I20200722001648 TX Practitioner - PathologyPractitioner - Dermatology 7517900889
I20201021001215 AR Practitioner - Pathology 7517900889

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
15162RLAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic Tissue/Cytology Group, PLLC Current Accepting new patients
Diagnostic Tissue/Cytology Group, PLLC Anatomic Pathology & Clinical Pathology Current Accepting new patients
Omega Diagnostics, LLC Current Accepting new patients
Laboratory Management Services - Technology Capital LLC PastSince Oct 1, 2012 Accepting new patients
The Delta Pathology Group, L.L.C. Past Accepting new patients

Locations

211 4th St
Alexandria, LA 71301
Phone (318) 473-3000

2915 Missouri Ave
Shreveport, LA 71109
Phone (318) 364-2000

3290 Knight St
Shreveport, LA 71105
Phone (318) 621-8820

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1174511653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3780",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 MISSOURI AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711094327",
            "telephone_number": "318-364-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESCHE",
        "first_name": "WILLIAM",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "15162R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11302019",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1161446",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.