NPIMap

Individual provider Active NPI

Bradley T Long, M.D.

  • Nephrology Physician
  • Oklahoma City, OK
National Provider Identifier
1295170496
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
34999 Issued in OK
Practice address
3366 NW Expressway Ste 550
Oklahoma City, OK 73112-4489
Phone
(405) 942-5442
NPI assigned
May 2, 2013
Last updated
Dec 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 18364 WI
Nephrology Physician 207RN0300X 34999 OK Primary

Addresses

Primary practice location

3366 NW Expressway Ste 550
Oklahoma City, OK 73112-4489

Mailing address

612 N. Kelham Avenue
Oklahoma City, OK 73117
Phone (405) 699-1105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20191202000250 OK Practitioner - Nephrology 2860718418 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Oklahoma College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians
Kidney Specialists of Central Oklahoma, PCGroup PAC ID 7618904988, 18 clinicians

Practice addresses (Care Compare)

3300 NW Expressway
Oklahoma City, OK 73112-4418
Phone (405) 949-3141

3366 NW Expressway
Suite 550
Oklahoma City, OK 73112-4489
Phone (405) 942-5442

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34999OKMDNephrology Physician
18364WIMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Specialists of Central Oklahoma, PC Nephrology CurrentSince Jan 1, 2020 Accepting new patients
Integris Ambulatory Care Corporation CurrentSince Apr 1, 2023 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

3300 NW Expressway St
Oklahoma City, OK 73112
Phone (405) 251-2815

3366 NW Expressway
Bldg D
Oklahoma City, OK 73112
Phone (405) 713-9930

3366 NW Expressway St
Ste 550
Oklahoma City, OK 73112
Phone (405) 942-5442

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

Interoperability endpoints

  • Direct secure messaging: blong19365@direct.acumenmd.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1295170496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 N. KELHAM AVENUE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73117",
            "telephone_number": "405-699-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3366 NW EXPRESSWAY STE 550",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124489",
            "telephone_number": "405-942-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "BRADLEY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-02",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "WI",
            "license": "18364",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OK",
            "license": "34999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.