NPIMap

Organization Active NPI

WK North Pulmonary & Critical Care

  • Critical Care Medicine (Internal Medicine) Physician
  • Shreveport, LA
National Provider Identifier
1265529648
Registry record updated Jun 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
Legal business name
WK NORTH PULMONARY & CRITICAL CARE
Practice address
2551 Greenwood Rd
Suite 210
Shreveport, LA 71103-3981
Phone
(318) 212-8946
Fax
(318) 212-4153
NPI assigned
Oct 6, 2006
Last updated
Jun 8, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2012

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

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X Primary
Pulmonary Disease Physician 207RP1001X

Addresses

Primary practice location

2551 Greenwood Rd
Suite 210
Shreveport, LA 71103-3981

Mailing address

1202 Louisian Ave.
Shreveport, LA 71101
Phone (318) 212-8546

Other identifiers 1

IdentifierTypeStateIssuer
1099252MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070116000196 LA Part B Supplier - Clinic/Group Practice 1759382856 Receives reassigned benefits from 26 practitioners
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

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

Locations

1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946

2751 Albert L Bicknell Dr
Ste 2C
Shreveport, LA 71103
Phone (318) 631-9190

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1265529648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIAN AVE.",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-212-8546",
            "fax_number": "318-212-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 210",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-212-8946",
            "fax_number": "318-212-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK NORTH PULMONARY & CRITICAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2012-06-08",
        "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": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1099252",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; 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.