WK Bossier Pulmonary & Critical Care Clinic

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

Legal business name

WK BOSSIER PULMONARY & CRITICAL CARE CLINIC

Practice address

2400 Hospital Dr
Suite 340
Bossier City, LA 71111-2385

Phone

(318) 747-2277

Fax

(318) 747-2217

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4232

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Locations

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Catrina Lewis, FNP

  • Family Nurse Practitioner
  • Bossier City, LA
  • NPI 1548019516

  LA

  Medicare reassignment Care Compare group NPD
• Raghu P Nathan, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Bossier City, LA
  • NPI 1457347429

  Critical Care Medicine, LA

  Medicare reassignment Care Compare group NPD
• Gerardo Santos San Pedro, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Bossier City, LA
  • NPI 1336166255

  Critical Care Medicine, LA

  Medicare reassignment Care Compare group NPD
• Ronald S Lambert, MD

  • Pulmonary Disease Physician
  • Bossier City, LA
  • NPI 1336196393

  LA, Pulmonary Disease

  Medicare reassignment NPD
• Sarah Tucker Allen, P.A.

  • Physician Assistant
  • Bossier City, LA
  • NPI 1295088656
  NPD (past)
• Lauren Gernand Banet, PA-C

  • Physician Assistant
  • Bossier City, LA
  • NPI 1922348887
  NPD (past)
• William S Cantwell, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Alexandria, LA
  • NPI 1851592075

  Critical Care Medicine

  NPD (past)
• Marleen Jannett Combs, FNP

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1720556855
  NPD (past)
• Savanna Dawn Eaves, ACNPC-AG

  • Acute Care Nurse Practitioner
  • Shreveport, LA
  • NPI 1477333128
  NPD (past)
• Sarah Estess, FNP

  • Family Nurse Practitioner
  • Bossier City, LA
  • NPI 1588088827
  NPD (past)
• Dustin Lane Chapman Hadley, PA-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1275051229
  NPD (past)
• Jason K Milligan, M.D.

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1114138864
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482105600000",
    "number": "1215149331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 340",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-747-2277",
            "fax_number": "318-747-2217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 340",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-747-2277",
            "fax_number": "318-747-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK BOSSIER PULMONARY & CRITICAL CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2016-12-19",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063487",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Bossier Internal Medicine
• WK Bossier OB GYN Specialists
• WK Bossier OB-GYN
• WK Bossier Orthopedic & Sports
• WK Bossier Pediatric Partners
• WK Bossier River Cities Interventional Pain Specialists
• WK Bossier Surgical Associates
• WK Bossier Urology Clinic
• WK Center for Ear Nose and Throat Disorders
• WK Ctr for Ear Nose and Throat Disorders

• All providers in Bossier City, LA
• Pulmonary Disease Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.