Simeon Wall Jr., MD, FACS

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

14159R Issued in LA

Practice address

8600 Fern Ave
Shreveport, LA 71105-5639

Phone

(318) 795-0801

Fax

(318) 795-9492

NPI assigned

Oct 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 27, 2016 through Sep 27, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Surgical Suites at the Wall Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Shreveport, LA
  • NPI 1386893758
  NPD (past) Authorized official
• The Plastic Surgery Center LLP

  • Plastic and Reconstructive Surgery Physician
  • Shreveport, LA
  • NPI 1700929874
  NPD (past)

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397088000000",
    "number": "1275522682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 FERN AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055639",
            "telephone_number": "318-795-0801",
            "fax_number": "318-795-9492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 FERN AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055639",
            "telephone_number": "318-795-0801",
            "fax_number": "318-795-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "SIMEON",
        "name_suffix": "Jr.",
        "credential": "MD, FACS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2014-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "LA",
            "license": "14159R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184292",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzette Walker
• Tyreunte Walker
• April Wilson Wall, DPT
• Forrest P Wall, M.D.
• Holly Casey Wall, MD, FACS
• Simeon H. Wall Sr., M.D.
• Wendell E. Wall, M.D.
• Aleric Wallace
• Ariante Vanae Wallace
• Casandra Wallace, M.S.

• Plastic and Reconstructive Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Plastic and Reconstructive Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.