NPIMap

Individual provider Active NPI

Jessica Beth Long, AGNP-C

  • Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1194244707
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
56895 Issued in ID
Practice address
420 E State St Ste 135
Eagle, ID 83616-4898
Phone
(208) 402-9956
NPI assigned
Sep 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 56895 ID Primary

Addresses

Primary practice location

420 E State St Ste 135
Eagle, ID 83616-4898

Mailing address

420 E State St Ste 135
Eagle, ID 83616-4898
Phone (208) 402-9956

Other names 1

  • Jessica Beth Mitchell Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180221001763 ID Practitioner - Nurse Practitioner 3577824234 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1673 W Shoreline Dr
Suite 100
Boise, ID 83702-6749
Phone (208) 593-3054

Hospital & facility affiliations

  • Multicare Home Health Services, Inc Home health agency, Meridian, ID, CCN 137093
  • Horizon Home Health Home health agency, Meridian, ID, CCN 137065
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
56895IDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Primary Care Adult and Geriatric Medicine Plllp CurrentSince Sep 4, 2023 Accepting new patients
MMG LLC Nurse Practitioner CurrentSince May 1, 2021 Accepting new patients
MMG LLC Nurse Practitioner CurrentSince May 1, 2021 Accepting new patients

Locations

1673 W Shoreline Dr
Ste 100
Boise, ID 83702
Phone (208) 322-0485

2440 S Titanium Pl
Meridian, ID 83642
Phone (208) 453-2659

746 E Winchester St
Ste 230B
Salt Lake City, UT 84107
Phone (801) 456-2333

Interoperability endpoints

  • Direct secure messaging: jessica.long.1@29411.direct.athenahealth.com

Organizations & group practices 3

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 9

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": "1505347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194244707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E STATE ST STE 135",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164898",
            "telephone_number": "208-402-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E STATE ST STE 135",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164898",
            "telephone_number": "208-402-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JESSICA",
        "middle_name": "BETH",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "56895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MITCHELL",
            "middle_name": "BETH",
            "credential": "RN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.