Individual provider Active NPI

Jeffrey John Longman, DC

  • Chiropractor
  • Wilmington, NC
National Provider Identifier
1104902709
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2794 Issued in NC
Practice address
8207 Market St
Suite D
Wilmington, NC 28411-8889
Phone
(910) 686-6508
Fax
(910) 686-8416
NPI assigned
Oct 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2794 NC Primary

Addresses

Primary practice location

8207 Market St
Suite D
Wilmington, NC 28411-8889

Mailing address

8207 Market St
Suite D
Wilmington, NC 28411-8889
Phone (910) 686-6508

Other identifiers 2

IdentifierTypeStateIssuer
085A0OtherNCBLUE CROSS BLUE SHIELD
662948OtherNCACN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110215000948 NC Practitioner - Chiropractic 2567659311 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Porters Neck Chiropractic IncGroup PAC ID 9133316987, 2 clinicians

Practice addresses (Care Compare)

8207 Market St D
Wilmington, NC 28411-9192
Phone (910) 686-6508

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2794NCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Porters Neck Chiropractic Inc Chiropractor CurrentSince May 1, 2000 Accepting new patients

Locations

8207 Market St
Ste D
Wilmington, NC 28411
Phone (910) 686-6508

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104902709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8207 MARKET ST",
            "address_2": "SUITE D",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284118889",
            "telephone_number": "910-686-6508",
            "fax_number": "910-686-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8207 MARKET ST",
            "address_2": "SUITE D",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284118889",
            "telephone_number": "910-686-6508",
            "fax_number": "910-686-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGMAN",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "085A0",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "662948",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.