Organization Active NPI

WK Internal Medicine Specialists

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1831579077
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WK INTERNAL MEDICINE SPECIALISTS
Practice address
8001 Youree Dr Ste 720
Shreveport, LA 71115-2336
Phone
(318) 212-3681
Fax
(318) 212-3687
NPI assigned
Jun 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Authorized official

Name
Greg J Gavin
Title
Network Administration
Phone
(318) 212-8780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

8001 Youree Dr Ste 720
Shreveport, LA 71115-2336

Mailing address

8001 Youree Dr Ste 720
Shreveport, LA 71115-2336
Phone (318) 212-3681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150806011498 LA Part B Supplier - Clinic/Group Practice 5799099537 Receives reassigned benefits from 2 practitioners
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2551 Greenwood Rd
Ste 320
Shreveport, LA 71103
Phone (318) 212-8176

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1831579077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR STE 720",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152336",
            "telephone_number": "318-212-3681",
            "fax_number": "318-212-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR STE 720",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152336",
            "telephone_number": "318-212-3681",
            "fax_number": "318-212-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK INTERNAL MEDICINE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATION",
        "authorized_official_telephone_number": "318-212-8780"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; 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.