Individual provider Active NPI

Benjamin Daniel Long, MD

  • Diagnostic Radiology Physician
  • Springfield, IL
National Provider Identifier
1043702392
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
125.071892 Issued in IL
Practice address
800 E Carpenter St
Springfield, IL 62769-4699
Phone
(217) 544-6464
NPI assigned
Jun 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 313938 NC
Diagnostic Radiology Physician 2085R0202X 125.071892 IL Primary

Addresses

Primary practice location

800 E Carpenter St
Springfield, IL 62769-4699

Mailing address

111 Oakwood Rd
East Peoria, IL 61611-1853
Phone (309) 740-4272

Other practice location 1

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240611003132 IL Practitioner - Diagnostic Radiology 8022366939 Reassigns benefits to 1 organization
I20240930003069 MO Practitioner - Diagnostic Radiology 8022366939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Michigan Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Illinois Radiological Associates LTDGroup PAC ID 9436061827, 205 clinicians

Practice addresses (Care Compare)

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

5200 Reliable Pkwy
Chicago, IL 60686-0052

9039 Saranac Dr
Richmond Heights, MO 63117-1022
Phone (309) 740-4272

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.071892ILMDDiagnostic Radiology Physician
313938NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maryville Imaging, LLC CurrentSince Dec 23, 2025 Accepting new patients
Central Illinois Radiological Associates, LTD. Diagnostic Radiology CurrentSince Jul 19, 2024 Accepting new patients
Maryville Imaging, LLC CurrentSince Dec 23, 2025 Accepting new patients
Cira Michigan PC Diagnostic Radiology Past Accepting new patients

Locations

5200 Reliable Pkwy
Chicago, IL 60686
Phone (309) 671-8748

5900 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-3060

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

111 Oakwood Rd
Peoria, IL 61611
Phone (586) 412-4144

530neglen Oak Ave
Peoria, IL 61636
Phone (309) 685-1054

800 E Carpenter St
Springfield, IL 62769
Phone (217) 525-5643

111 Spring St
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 4

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 6

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": "1527897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1043702392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OAKWOOD RD",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111853",
            "telephone_number": "309-740-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E CARPENTER ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627694699",
            "telephone_number": "217-544-6464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277054699",
            "country_code": "US",
            "telephone_number": "919-684-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "BENJAMIN",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-02",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "313938",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "125.071892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.