NPIMap

Individual provider Active NPI

Gina Lynne Wilson, MD

  • Vascular & Interventional Radiology Physician
  • Covington, LA
National Provider Identifier
1215908496
Registry record updated Sep 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD201912 Issued in LA
Practice address
67252 Industry LN Ste 100
Covington, LA 70433-8704
Phone
(985) 801-6212
NPI assigned
Jan 27, 2006
Last updated
Sep 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X MD201912 LA Primary

Addresses

Primary practice location

67252 Industry LN Ste 100
Covington, LA 70433-8704

Mailing address

65 Juniper CT
Mandeville, LA 70471-6795
Phone (985) 801-6216

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, TN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080411000539 LA Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 7315024585 Reassigns benefits to 1 organization
I20200411000572 TN Practitioner - Diagnostic Radiology 7315024585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tulane University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Womens Diagnostic Group PLLCGroup PAC ID 7113967795, 4 clinicians

Practice addresses (Care Compare)

50 Humphreys Ctr Dr
Suite 23
Memphis, TN 38120-2369
Phone (901) 226-0810

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD201912LAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsu Health Sciences Center Shreveport Faculty Group Practice CurrentSince Dec 1, 2016 Accepting new patients
Womens Diagnostic Group PLLC Diagnostic Radiology CurrentSince Jan 18, 2020 Accepting new patients
Summit Radiology P C Diagnostic Radiology Past Accepting new patients
Diagnostic Radiology Consultants, LLP Diagnostic Radiology Past Accepting new patients
St. Joseph Health System, LLC Past Accepting new patients
Imaging Diagnostic Center Limited Diagnostic Radiology Past Accepting new patients
Digital Imaging Solutions, LLC Diagnostic Radiology Past Accepting new patients

Locations

1501 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0434

1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

50 Humphreys Center Dr
Ste 23
Memphis, TN 38120
Phone (901) 226-0810

Organizations & group practices 7

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": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789689600000",
    "number": "1215908496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 JUNIPER CT",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704716795",
            "telephone_number": "985-801-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67252 INDUSTRY LN STE 100",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704338704",
            "telephone_number": "985-801-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GINA",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "LA",
            "license": "MD201912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.