WK Moller Cassiere Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WK MOLLER CASSIERE CLINIC

Practice address

8001 Youree Dr
Suite 400
Shreveport, LA 71115-2302

Phone

(318) 212-3456

Fax

(318) 212-3885

NPI assigned

Jun 10, 2006

Last updated

Jun 8, 2012By the provider in NPPES

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 III

Title

Network Administrator

Phone

(318) 212-8780

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.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572

  Member Of

  NPD member

Practitioners 10

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.

• David Abdehou, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1568471993
  Medicare reassignment Care Compare group NPD
• Kimberly Armstrong

  • Nurse Practitioner
  • Shreveport, LA
  • NPI 1508473893
  Medicare reassignment Care Compare group NPD
• Sally S. Ball, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1568441251
  Medicare reassignment Care Compare group NPD
• Anne Z Boteler, NP

  • Acute Care Nurse Practitioner
  • Shreveport, LA
  • NPI 1477287688
  Medicare reassignment Care Compare group NPD
• Jacquline D Jansen, FNP-C

  • Nurse Practitioner
  • Shreveport, LA
  • NPI 1801408547
  Medicare reassignment Care Compare group NPD
• Scott McRight, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1568605004
  Medicare reassignment Care Compare group NPD
• Mohammed Syed, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1972031664
  Medicare reassignment Care Compare group NPD
• Lensey Wells Tiller, FNP-C

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1568915320
  Medicare reassignment Care Compare group NPD
• Cody Tingle, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1699031237
  Medicare reassignment Care Compare group NPD
• Ahmed Salem, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Sarasota, FL
  • NPI 1760914055

  Internal Medicine, LA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1538101290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR",
            "address_2": "SUITE 400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152302",
            "telephone_number": "318-212-3456",
            "fax_number": "318-212-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR",
            "address_2": "SUITE 400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152302",
            "telephone_number": "318-212-3456",
            "fax_number": "318-212-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK MOLLER CASSIERE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "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": "318-212-8780",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452912",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Hyperbaric & Wound Care Center
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• WK Mid South Orthopedics
• WK Minimally Invasive Surgery Center
• WK Neurology Consultants
• WK Neurosurgical Associates
• WK Neurovascular Neurosurgery
• WK North Dermatology Clinic
• WK North Gynecology Clinic

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal 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.