Kimberly Ann Longo
Individual provider Active NPI Family Nurse Practitioner · Hagerstown, MD
NPI 1356091888 · NPPES record last updated Nov 1, 2023
Key facts
- NPI
- 1356091888
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R169573 (MD)
- Practice address
- 324 E Antietam St
Hagerstown, MD 21740-5754 - Phone
- (240) 362-7128
- Fax
- (240) 362-7731
- NPI assigned
- Mar 27, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Medstar Health Weight Management, LLC
Practice addresses (Care Compare)
499 Idlewild Ave
Suite 104
Easton, MD 21601-4049
Phone (410) 697-3832
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220919000524 | MD | Practitioner - Nurse Practitioner | 4183009772 | Reassigns benefits to 4 organizations |
| I20240621001773 | DC | Practitioner - Nurse Practitioner | 4183009772 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garrett Anesthesia and Pain Management | Current |
Accepting new patients | |
| Medstar Health Weight Management, LLC | Current |
Accepting new patients | |
| Garrett Anesthesia and Pain Management | Current |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
6700 Race Track Rd
Bowie, MD 20715
Phone (301) 383-2581
499 Idlewild Ave
Ste 104
Easton, MD 21601
Phone (410) 697-3832
118 E Oak Ridge Dr
Ste 1100
Hagerstown, MD 21740
Phone (240) 382-1312
324 E Antietam St
Ste 306A
Hagerstown, MD 21740
Phone (240) 469-0094
957 National Hwy
Ste 3
Lavale, MD 21502
Phone (240) 362-7128
1099 Winterson Rd
Ste 300
Linthicum Heights, MD 21090
Phone (443) 929-1785
Interoperability endpoints
- longo.kimberly@ca-md.direct.office.nextgen.com
- kimberly.longo.1@11878.direct.athenahealth.com
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R169573 | MD | Yes |
Addresses
Primary practice location
324 E Antietam St
Hagerstown, MD 21740-5754
Mailing address
324 E Antietam St
Hagerstown, MD 21740-5754
Phone (240) 362-7128
Other providers in Hagerstown, MD
- Donna E Lofton
- Jaime Long
- Toby Allison Long
- Longmeadow Eyecare Incorporated
- Longmeadow Family Dental Care
- Taryn Christine Longstreth
- Fern Elizabeth Loomis
- Karin Looper
- Daisy Lopez-Duke
- Eric Mark Jaurigue Lopez
All providers in Hagerstown, MD · Family Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.