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SIMEON WALL JR. MD, FACS
NPI 1275522682
Surgery - Plastic and Reconstructive Surgery in Shreveport, LA

Active since October 18, 2005Opted out of Medicare · through Sep 27, 2026
8600 FERN AVE, SHREVEPORT, LA 71105(318) 795-0801(318) 795-9492 Get Directions Write a Review

NPPES record last updated: April 10, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Simeon Wall Jr. Md, Facs NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIMEON WALL JR. MD, FACS (NPI 1275522682) is an individual plastic and reconstructive surgery provider in Shreveport, Louisiana, licensed in Louisiana (14159R) and active in the NPI registry since October 2005. He has opted out of Medicare through September 27, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1275522682
Entity TypeIndividualMale
Primary Taxonomy2086S0122X
Provider Legal NameSIMEON WALL JR.Credential: MD, FACS
Location Address8600 FERN AVEShreveport, LA 71105-5639
Mailing Address8600 Fern AveShreveport, LA 71105-5639 · (318) 795-0801 · Fax (318) 795-9492
Phone(318) 795-0801
Fax(318) 795-9492
Sole ProprietorNo
Enumeration DateOctober 18, 2005
Last NPPES UpdateApril 10, 2014
✔ NPI 1275522682 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in LA · 14159R
Definition
A surgeon who specializes in plastic and reconstructive surgery.
8600 FERN AVE, Shreveport, LA 71105
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Other Identifiers 3

Medicare ID-Type Unspecified4A494
Medicaid1184292LA
Medicare UPINH44152

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Simeon Wall Jr. Md, Facs has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 27, 2016 through September 27, 2026.

Opt-Out Effective DateSeptember 27, 2016
Opt-Out In Effect ThroughSeptember 27, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HOLLY CASEY WALL MD, FACS
Surgery (Plastic and Reconstructive Surgery)
8600 FERN AVE
SHREVEPORT, LA 71105
Caddo Parish (318) 795-0801
DR. SIMEON H. WALL SR. M.D.
Specialist
8600 FERN AVE
SHREVEPORT, LA 71105
Caddo Parish (318) 795-0801
MRS. JEANNIE SHIM MCALLISTER PA-C
Physician Assistant (Medical)
8600 FERN AVE
SHREVEPORT, LA 71105
Caddo Parish (318) 213-1772
SIMEON H. WALL, MD A PROFESSIONAL MEDICAL CORP
Plastic Surgery
8600 FERN AVE
SHREVEPORT, LA 71105
Caddo Parish (318) 795-0801

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Simeon Wall's NPI number?

The NPI number for Simeon Wall is 1275522682. It was assigned to this individual provider in the NPPES registry on October 18, 2005.

Where is Simeon Wall located?

Simeon Wall practices at 8600 Fern Ave, Shreveport, LA 71105. The listed phone number is (318) 795-0801.

What is Simeon Wall's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Is Simeon Wall enrolled in Medicare?

No. Simeon Wall has opted out of Medicare through September 27, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Simeon Wall was last updated on April 10, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.