WK Shreveport Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WK SHREVEPORT INTERNAL MEDICINE

Practice address

1449 E Bert Kouns Industrial Loop Ste 100
Shreveport, LA 71105-5680

Phone

(318) 629-0220

Fax

(318) 629-0230

NPI assigned

Jun 30, 2023

Organization subpart

No

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

Authorized official

Name

Mary Jane Ward

Title

Senior VP Finance

Phone

(318) 716-4939

Specialties & licenses 1

Addresses

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.

  dba WK Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shreveport, LA
  • NPI 1003020579

  Member Of

  NPD member

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lindsey Beck Bradley, FNP-BC

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1548002918

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Mark Alan Brown

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1750344073
  Medicare reassignment Care Compare group NPD
• Summer Cone Hanson

  • Nurse Practitioner
  • Shreveport, LA
  • NPI 1487311023
  Medicare reassignment Care Compare group NPD
• Craig L. Miller, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1174590848
  Medicare reassignment Care Compare group NPD
• Eric W Smith, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1417910720
  Medicare reassignment Care Compare group NPD
• Robert Wilson Eastwood, PA

  • Physician Assistant
  • Shreveport, LA
  • NPI 1427269893
  Medicare reassignment Care Compare group
• Mary Inman, ACNPC-AG

  • Gerontology Nurse Practitioner
  • Shreveport, LA
  • NPI 1780237701
  NPD
• Richard James Michael, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1861496671
  NPD
• Ashley Raburn, PA-C

  • Medical Physician Assistant
  • Baton Rouge, LA
  • NPI 1477995645
  NPD (past)

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1255018388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-716-4939",
            "fax_number": "318-716-4854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 E BERT KOUNS INDUSTRIAL LOOP STE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055680",
            "telephone_number": "318-629-0220",
            "fax_number": "318-629-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK SHREVEPORT INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "SENIOR VP FINANCE",
        "authorized_official_telephone_number": "318-716-4939"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Robotic and Laparoscopic Surgery Clinic
• WK Shreveport Behavioral Wellness Center
• WK Shreveport Breast Center
• WK Shreveport Center for Geriatric Health
• WK Shreveport Infectious Disease
• WK Shreveport Sleep Medicine
• WK Signature Urology Clinic
• WK South Audiology Center
• WK South Hospitalists
• WK South OB-GYN Clinic

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.