Individual provider Active NPI

Miranda C Long, P.A.

  • Physician Assistant
  • Sterling, IL
National Provider Identifier
1245742352
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.006398 Issued in IL
Practice address
101 E Miller Rd
Sterling, IL 61081-1252
Phone
(815) 625-4790
NPI assigned
Oct 30, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.006398 IL Primary

Addresses

Primary practice location

101 E Miller Rd
Sterling, IL 61081-1252

Mailing address

101 E Miller Rd
Sterling, IL 61081-1252
Phone (815) 625-4790

Other names 1

  • Miranda C Teller Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180122000113 IL Practitioner - Physician Assistant 2365701364 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CGH Medical CenterGroup PAC ID 6103723267, 199 clinicians

Practice addresses (Care Compare)

101 E Miller Rd
Sterling, IL 61081-1252
Phone (815) 625-4790

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.006398ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
CGH Medical Center CurrentSince Nov 11, 2017 Accepting new patients
CGH Medical Center Past Accepting new patients

Locations

101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285

101 E Miller Rd
Ste 100
Sterling, IL 61081

Interoperability endpoints

  • Direct secure messaging: mlong20785@cghmc.direct-ci.com

Organizations & group practices 2

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 1

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": "1509321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1245742352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E MILLER RD",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811252",
            "telephone_number": "815-625-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E MILLER RD",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610811252",
            "telephone_number": "815-625-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "MIRANDA",
        "middle_name": "C",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-30",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "TELLER",
            "middle_name": "C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sterling, IL

Sources for this page

Verify at the official NPI Registry.