WK Swan Lake Diabetes & Endocrinology

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

Legal business name

WK SWAN LAKE DIABETES & ENDOCRINOLOGY

Practice address

5341 Airline Drive
Suite 100
Bossier City, LA 71111

Phone

(318) 935-1810

Fax

(318) 935-1867

NPI assigned

May 25, 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

Sr. VP Finance

Phone

(318) 716-4937

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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 1

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

• Derek Rainwater, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Bossier City, LA
  • NPI 1548767437
  Medicare reassignment NPD

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1326730573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5341 AIRLINE DRIVE",
            "address_2": "SUITE 100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "318-935-1810",
            "fax_number": "318-935-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5341 AIRLINE DRIVE",
            "address_2": "SUITE 100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "318-935-1810",
            "fax_number": "318-935-1867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK SWAN LAKE DIABETES & ENDOCRINOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "SR. VP FINANCE",
        "authorized_official_telephone_number": "318-716-4937"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Precision Neurosurgery
• WK Preferred Pediatrics
• WK Premier Pediatrics
• WK Red River Internal Medicine
• WK Spine & Pain Specialists
• WK Urgent Care Center - Bossier
• WK Womens Health Associates
• WK Zaffater Eye Center
• WKB Family Medicine Associates
• Joshua Wolf

• Endocrinology, Diabetes & Metabolism Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Endocrinology, Diabetes & Metabolism Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.