Individual provider Active NPI

Jessica Rose Long, MD

  • Obstetrics & Gynecology Physician
  • Chicago, IL
National Provider Identifier
1346779063
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
125070845 Issued in IL
Practice address
5841 S Maryland Ave # Mc2050
Chicago, IL 60637-1447
Phone
(773) 834-0598
NPI assigned
Jun 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 125070845 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave # Mc2050
Chicago, IL 60637-1447

Mailing address

10 Center Drive RM 8N248 Msc1840
Bethesda, MD 20892-0001
Phone (301) 435-6926

Other identifiers 1

IdentifierTypeStateIssuer
125070845OtherILLICENSE NUMBER

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231019001924 IL Practitioner - Obstetrics/Gynecology 1153690961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Massachusetts Medical School, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200

Hospital & facility affiliations

  • The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Chicago CurrentSince Sep 1, 2023 Accepting new patients
The University of Chicago Medical Center CurrentSince Sep 1, 2023 Accepting new patients
The University of Chicago Medical Center CurrentSince Sep 1, 2023 Accepting new patients

Locations

180 Harvester Dr
Ste 110
Burr Ridge, IL 60527
Phone (773) 702-1061

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

355 E Grand Ave
Chicago, IL 60611
Phone (312) 587-3432

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Interoperability endpoints

  • Direct secure messaging: jlongmd152074@uchospital.direct-ci.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 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": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1346779063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CENTER DRIVE RM 8N248 MSC1840",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208920001",
            "telephone_number": "301-435-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE # MC2050",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-834-0598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JESSICA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-06",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "125070845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "125070845",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.