DR. SIMEON H. WALL SR. M.D.
NPI 1700939147
Specialist in Shreveport, LA

Q: What is Simeon Wall's NPI number?

The NPI number for Simeon Wall is 1700939147. It was assigned to this individual provider in the NPPES registry on January 19, 2007.

Q: What is Simeon Wall's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Q: Is Simeon Wall enrolled in Medicare?

No. Simeon Wall has opted out of Medicare through September 29, 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.

Q: When was this NPI record last updated?

The NPPES record for Simeon Wall was last updated on February 22, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since January 19, 2007Opted out of Medicare · through Sep 29, 2026

8600 FERN AVE, SHREVEPORT, LA 71105(318) 795-0801(318) 795-9492 Get Directions Write a Review

NPPES record last updated: February 22, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Simeon H. Wall Sr. M.d. NPPES

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

DR. SIMEON H. WALL SR. M.D. (NPI 1700939147) is an individual specialist in Shreveport, Louisiana, licensed in Louisiana (02970R) and active in the NPI registry since January 2007. He has opted out of Medicare through September 29, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1700939147

Entity TypeIndividualMale

Primary Taxonomy174400000X

Provider Legal NameDR. SIMEON H. WALL SR.Credential: M.D.

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 ProprietorYes

Enumeration DateJanuary 19, 2007

Last NPPES UpdateFebruary 22, 2012

✔ NPI 1700939147 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in LA · 02970R

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

8600 FERN AVE, Shreveport, LA 71105

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Other Identifiers 2

Medicare ID-Type Unspecified5L694LA · Plastic Surgery

Medicare UPINB61438LA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Simeon H. Wall Sr. M.d. 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 29, 2016 through September 29, 2026.

Opt-Out Effective DateSeptember 29, 2016

Opt-Out In Effect ThroughSeptember 29, 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

SIMEON WALL JR. MD, FACS

Surgery (Plastic and Reconstructive Surgery)

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 1700939147. It was assigned to this individual provider in the NPPES registry on January 19, 2007.

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 Specialist with taxonomy code 174400000X.

Is Simeon Wall enrolled in Medicare?

No. Simeon Wall has opted out of Medicare through September 29, 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 February 22, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.