Individual provider Active NPI

Maria Isabel Longo-Imedio, MD

  • Dermatology Physician
  • State College, PA
National Provider Identifier
1285028126
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD486832 Issued in PA
Practice address
303 Benner Pike
State College, PA 16801-7304
Phone
(814) 272-5660
Fax
(814) 272-5675
NPI assigned
Mar 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD486832 PA Primary
Dermatology Physician 207N00000X 282851828 ZZ

Addresses

Primary practice location

303 Benner Pike
State College, PA 16801-7304

Mailing address

500 University Dr
MC Ca410
Hershey, PA 17033-2360
Phone (717) 531-1159

Other practice location 1

4037 NW 86th Ter
Fourth Floor
Gainesville, FL 32606-9277
Phone (352) 594-1500

Other identifiers 1

IdentifierTypeStateIssuer
015478700MedicaidFL

Other names 1

  • Maria Isabel Longo Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, PA2 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
I20151006003139 FL Practitioner - Dermatology 7416265798 Reassigns benefits to 1 organization
I20241231001787 PA Practitioner - Dermatology 7416265798 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Milton S Hershey Medical Center Physicians GroupGroup PAC ID 3870405483, 1,606 clinicians

Practice addresses (Care Compare)

303 Benner Pike
State College, PA 16801-7304
Phone (814) 272-4400

Hospital & facility affiliations

  • Milton S Hershey Medical Center Hospital, Hershey, PA, CCN 390256
  • Mount Nittany Medical Center Hospital, State College, PA, CCN 390268

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision12
Removal of skin lesions344
Removal or shaving of skin growth1-10
Skin biopsy156

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD486832PAMDDermatology Physician
282851828ZZMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group CurrentSince Jan 13, 2025 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Jan 13, 2025 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Sep 1, 2015 Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Sep 1, 2015 Accepting new patients
The Milton S. Hershey Medical Center Physicians Group Dermatology Past Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

4037 NW 86th Ter
Fl Fourth
Gainesville, FL 32606
Phone (352) 594-1500

500 University Dr
#410
Hershey, PA 17033
Phone (717) 531-1159

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

500 University Dr
#A4
Hershey, PA 17033
Phone (717) 531-6261

303 Benner Pike
State College, PA 16801
Phone (814) 272-4400

303 Benner Pike
Ste 1
State College, PA 16801
Phone (814) 272-5660

Organizations & group practices 6

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": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1285028126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "address_2": "MC CA410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "717-531-1159",
            "fax_number": "717-531-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 BENNER PIKE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017304",
            "telephone_number": "814-272-5660",
            "fax_number": "814-272-5675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4037 NW 86th Ter",
            "address_2": "Fourth Floor",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326069277",
            "country_code": "US",
            "telephone_number": "352-594-1500",
            "fax_number": "352-594-1501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONGO-IMEDIO",
        "first_name": "MARIA",
        "middle_name": "ISABEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD486832",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ZZ",
            "license": "282851828",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015478700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "LONGO",
            "middle_name": "ISABEL",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.