Individual provider Active NPI

Maxwell C McDonald III, MD

  • Hematology & Oncology Physician
  • Shreveport, LA
National Provider Identifier
1699764589
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
025699 Issued in LA
Practice address
2600 Kings Hwy
Suite 340
Shreveport, LA 71103-3950
Phone
(318) 212-8620
Fax
(318) 212-8625
NPI assigned
Oct 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 025699 LA
Hematology & Oncology Physician 207RH0003X 025699 LA Primary

Addresses

Primary practice location

2600 Kings Hwy
Suite 340
Shreveport, LA 71103-3950

Mailing address

2600 Kings Hwy
Suite 340
Shreveport, LA 71103-3950
Phone (318) 212-8620

Other identifiers 1

IdentifierTypeStateIssuer
1041521MedicaidLA

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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041019000188 LA Practitioner - Hematology/OncologyPractitioner - Internal Medicine 1759341209 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Louisiana State University School of Medicine in Shreveport, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Hematology Oncology AssociatesGroup PAC ID 5597779959, 9 clinicians

Practice addresses (Care Compare)

2600 Kings Hwy
Suite 340
Shreveport, LA 71103-3951
Phone (318) 212-8620

Hospital & facility affiliations

  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
  • Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041

Merit-based Incentive Payment System (MIPS)

Final score
91.53 of 100Reported as apm
Quality
81.42
Promoting interoperability
94.6
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
025699LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
WK Hematology Oncology Associates Hematology & Oncology CurrentSince Jun 1, 2007 Accepting new patients
WK Advanced Urology PastSince Jun 1, 2007 Accepting new patients

Locations

2600 Kings Hwy
Ste 300
Shreveport, LA 71103
Phone (318) 212-8344

8001 Youree Dr
Ste 500
Shreveport, LA 71115
Phone (318) 212-3702

2600 Kings Hwy
Ste 340
Shreveport, LA 71103
Phone (318) 212-3702

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1699764589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 KINGS HWY",
            "address_2": "SUITE 340",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033950",
            "telephone_number": "318-212-8620",
            "fax_number": "318-212-8625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 KINGS HWY",
            "address_2": "SUITE 340",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033950",
            "telephone_number": "318-212-8620",
            "fax_number": "318-212-8625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "MAXWELL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "025699",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "LA",
            "license": "025699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1041521",
            "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.