WK Red River Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WK RED RIVER INTERNAL MEDICINE

Practice address

2300 Hospital Dr
Suite 320
Bossier City, LA 71111-2394

Phone

(318) 212-7848

Fax

(318) 212-7855

NPI assigned

May 14, 2010

Last updated

Jun 11, 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

Mr. Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4132

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

Locations

Practitioners 5

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.

• Lindsey Hernandez, FNP-C

  • Family Nurse Practitioner
  • Bossier City, LA
  • NPI 1598482861
  Medicare reassignment Care Compare group NPD
• Leslie Jean Sewell, MD

  • Internal Medicine Physician
  • Bossier City, LA
  • NPI 1083655971
  Medicare reassignment Care Compare group NPD
• Cortney L Young, FNP

  • Family Nurse Practitioner
  • Bossier City, LA
  • NPI 1093086274
  Medicare reassignment Care Compare group NPD
• Emily Leanne Tull, NP

  • Acute Care Nurse Practitioner
  • Bossier City, LA
  • NPI 1386137586
  Medicare reassignment Care Compare group
• Lindsey Beck Bradley, FNP-BC

  • Family Nurse Practitioner
  • Shreveport, LA
  • NPI 1548002918

  Internal Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1992023998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "SUITE 320",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-212-7848",
            "fax_number": "318-212-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "SUITE 320",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-212-7848",
            "fax_number": "318-212-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK RED RIVER INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-14",
        "last_updated": "2012-06-11",
        "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": "318-212-4132",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Neurology Clinic
• WK North Bossier ENT
• WK Precision Neurosurgery
• WK Preferred Pediatrics
• WK Premier Pediatrics
• WK Spine & Pain Specialists
• WK Swan Lake Diabetes & Endocrinology
• WK Urgent Care Center - Bossier
• WK Womens Health Associates
• WK Zaffater Eye Center

• Internal Medicine Physician in Bossier City, LA
• Providers in Bossier City, 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 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.