Kenneth Michael Long, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

22826 Issued in MS

Practice address

5907 Highway 90
Moss Point, MS 39563-6536

Phone

(228) 769-2611

NPI assigned

Jun 17, 2011

Last updated

Jan 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS, LA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.long.2@9582.direct.athenahealth.com

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.

• Mississippi Providence Healthcare Services Inc.

  • Family Medicine Physician
  • Mobile, AL
  • NPI 1821340407

  MS

  Medicare reassignment NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • New Orleans, LA
  • NPI 1538151428
  Medicare reassignment NPD
• Ochsner Clinic LLC

  dba Diabetes Prevention Program

  • Registered Dietitian
  • Covington, LA
  • NPI 1013747039
  NPD
• Ochsner Clinic LLC

  dba Ochsner St. Anne Specialty Clinic

  • General Practice Physician
  • Raceland, LA
  • NPI 1699072041
  NPD
• USA Health Community Providers LLC

  • Family Medicine Physician
  • Mobile, AL
  • NPI 1801571823
  NPD
• Hattiesburg Clinic PA

  dba Picayune Family Clinic

  • Family Medicine Physician
  • Picayune, MS
  • NPI 1265593156
  NPD (past)

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

{
    "created_epoch": "1308268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1346535390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5907 HIGHWAY 90",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636536",
            "telephone_number": "504-842-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5907 HIGHWAY 90",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395636536",
            "telephone_number": "228-769-2611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "128 Highland Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Picayune",
            "state": "MS",
            "postal_code": "394665578",
            "country_code": "US",
            "telephone_number": "601-358-9630",
            "fax_number": "601-358-9640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "128 Highland Pkwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Picayune",
            "state": "MS",
            "postal_code": "394665578",
            "country_code": "US",
            "telephone_number": "601-358-9630",
            "fax_number": "601-358-9640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2750 Gause Blvd E",
            "address_purpose": "LOCATION",
            "city": "Slidell",
            "state": "LA",
            "postal_code": "70461",
            "country_code": "US",
            "telephone_number": "985-639-3777",
            "fax_number": "985-639-3701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-17",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "311654",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "22826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08224277",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01332510",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luci G Knotts, CCC-SLP
• Michael Knotts, MSN, NP-C
• Kasey Staten Kringle, DMD
• Eric Landon, NP
• Allen Elliott Lane, RPH.
• Sarah Mallette, NP
• Jessica McDonald
• Patrick Conrad McGuire II, MD
• Reba J McMellon, M.S., LPC
• Steve McMellon, RPH

• Family Medicine Physician in Moss Point, MS
• Providers in Moss Point, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.