WK Pierremont Family Physicians

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WK PIERREMONT FAMILY PHYSICIANS

Practice address

8001 Youree Dr
Suite 540
Shreveport, LA 71115-2302

Phone

(318) 212-3793

Fax

(318) 212-3799

NPI assigned

Apr 2, 2007

Organization subpart

No

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 1

Addresses

Other identifiers 1

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.

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Locations

Practitioners 6

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

• Sara Amend Blankenship

  • Nurse Practitioner
  • Shreveport, LA
  • NPI 1811518780
  Medicare reassignment Care Compare group NPD
• Russell Shane Carr, M.D.

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1245205335
  Medicare reassignment Care Compare group NPD
• Larry Lucas Flake, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1386670917
  Medicare reassignment Care Compare group NPD
• Peter Klucar, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1104322833
  Medicare reassignment Care Compare group NPD
• Wendy McBride Moses, MD

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1487681730
  Medicare reassignment Care Compare group NPD
• Kristen Ruth Bass, PA-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1093015885
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1497876189",
    "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": "318-212-3793",
            "fax_number": "318-212-3799"
        },
        {
            "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": "318-212-3793",
            "fax_number": "318-212-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK PIERREMONT FAMILY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "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": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009091",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Pierremont Associates in Internal Medicine
• WK Pierremont Cardiology
• WK Pierremont Endocrine Center
• WK Pierremont ENT
• WK Pierremont Eye Institute
• WK Pierremont Hospitalists
• WK Pierremont Internal Medicine Associates
• WK Pierremont Neurology Clinic
• WK Pierremont OB-GYN Specialists
• WK Pierremont Pediatrics

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

• 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.