NPIMap

Individual provider Active NPI

Larry Lucas Flake, MD

  • Family Medicine Physician
  • Shreveport, LA
National Provider Identifier
1386670917
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
019421 Issued in LA
Practice address
8001 Youree Dr
Suite 540
Shreveport, LA 71115-2302
Phone
(318) 212-3810
Fax
(318) 212-3815
NPI assigned
Jun 24, 2006
Last updated
Jul 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 019421 LA Primary

Addresses

Primary practice location

8001 Youree Dr
Suite 540
Shreveport, LA 71115-2302

Mailing address

8001 Youree Dr
Suite 540
Shreveport, LA 71115-2302
Phone (318) 212-3810

Other identifiers 1

IdentifierTypeStateIssuer
1910937MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000587 LA Practitioner - Family Practice 9537260369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in Shreveport, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Pierremont Family PhysiciansGroup PAC ID 0143320465, 6 clinicians
Cornerstone Therapy and Balance Center, LLCGroup PAC ID 0345397899, 98 clinicians

Practice addresses (Care Compare)

1811 E Bert Kouns Industrial Loop
Suite 400
Shreveport, LA 71105-5764
Phone (318) 212-3810

8961 Youree Dr
Shreveport, LA 71115-3001
Phone (318) 671-8772

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019421LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
WK Pierremont Family Physicians Family Medicine CurrentSince Aug 1, 2007 Accepting new patients

Locations

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

1811 E Bert Kouns Industrial Loop
Ste 400
Shreveport, LA 71105
Phone (318) 212-3810

8001 Youree Dr
Ste 540
Shreveport, LA 71115
Phone (318) 212-3787

Interoperability endpoints

  • Direct secure messaging: lflake@direct.wkhs.com

Organizations & group practices 2

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 8

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1386670917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR",
            "address_2": "SUITE 540",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152302",
            "telephone_number": "318-212-3810",
            "fax_number": "318-212-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR",
            "address_2": "SUITE 540",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152302",
            "telephone_number": "318-212-3810",
            "fax_number": "318-212-3815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAKE",
        "first_name": "LARRY",
        "middle_name": "LUCAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "019421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1910937",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.