Randall Mark Wilk, MD DDS PHD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

022962 Issued in LA

Practice address

120 Meadowcrest St.
Suite 300
Gretna, LA 70056

Phone

(504) 362-6135

Fax

(504) 362-6134

NPI assigned

Sep 15, 2006

Last updated

Apr 22, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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.

Enrollment records 1

Specialty

Maxillofacial SurgeryAlso: Surgical Oncology

Education

Louisiana State University School of Medicine in New Orleans, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8550/brand/1/csg/1/fhir/r4
• Direct secure messaging: minyon@randallwilk.directde.com

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.

• Randall M. Wilk, MD, DDS, PHD, Apmc

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Gretna, LA
  • NPI 1285849166

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD Authorized official
• Nola Surgical Specialists

  • Oral and Maxillofacial Surgery (Dentist)
  • New Orleans, LA
  • NPI 1427995075
  NPD
• Anthony a Indovina DDS and Robert M Laughlin DMD Oral and Maxillofacia

  dba Indovina and Laughlin Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Marrero, LA
  • NPI 1295449205
  NPD (past)
• Lsu Health Sciences Center Lsu Faculty Dental Practice

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Metairie, LA
  • NPI 1295837326
  NPD (past)
• Spinecare Medical Group

  • Specialist
  • Gretna, LA
  • NPI 1467540179
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366588800000",
    "number": "1669578944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MEADOWCREST ST.",
            "address_2": "SUITE 300",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "70056",
            "telephone_number": "504-362-6135",
            "fax_number": "504-362-6134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEADOWCREST ST.",
            "address_2": "SUITE 300",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "70056",
            "telephone_number": "504-362-6135",
            "fax_number": "504-362-6134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILK",
        "first_name": "RANDALL",
        "middle_name": "MARK",
        "credential": "MD DDS PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2013-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "4669",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "LA",
            "license": "022962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rachel Lynn White, MASSAGE THERAPIST
• David Eugene Whitehead Jr.
• Ijale Wilkerson
• Joey Meko Williams-Thompson
• Angel Nicole Williams, RSW
• Joyce Elaine/Raby Williams, FNP
• Kelly Williams

• Oral & Maxillofacial Surgery (D.M.D.) in Gretna, LA
• Providers in Gretna, LA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; 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.
• 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.