NPIMap

Individual provider Active NPI

Robert Lawrence Long, M.D.

  • Urology Physician
  • Fort Walton Beach, FL
National Provider Identifier
1356317002
Registry record updated Dec 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME0043999 Issued in FL
Practice address
909 Mar Walt Dr
Suite 1011
Fort Walton Beach, FL 32547-6635
Phone
(850) 863-3377
NPI assigned
Feb 23, 2006
Last updated
Dec 8, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X ME0043999 FL Primary

Addresses

Primary practice location

909 Mar Walt Dr
Suite 1011
Fort Walton Beach, FL 32547-6635

Mailing address

2234 Colonial Blvd
Managed Care Dept
Fort Myers, FL 33907-1412
Phone (239) 931-7342

Other identifiers 4

IdentifierTypeStateIssuer
382563OtherFLAVMED
1193377OtherFLWELLCARE
P00728665OtherFLRR MEDICARE
47173OtherFLBCBS OF FL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20161205001047 AL Practitioner - Urology 8123185162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Kentucky College of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

301 Medical Ave a
Andalusia, AL 36420-1102
Phone (334) 222-2418

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0043999FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Andalusia Physician Practices LLC CurrentSince Apr 1, 2017 Accepting new patients
Andalusia Physician Practices LLC Current Accepting new patients
Andalusia Physician Practices LLC Urology CurrentSince Apr 1, 2017 Accepting new patients
Andalusia Physician Practices LLC Past Accepting new patients
White-Wilson Medical Center PA Past Accepting new patients
Andalusia Professional Services LLC Past Accepting new patients

Locations

300 Medical Ave
Ste 100
Andalusia, AL 36420
Phone (334) 222-2393

301 Medical Ave
Ste A
Andalusia, AL 36420
Phone (334) 222-9100

301 Medical Ave
Ste C
Andalusia, AL 36420
Phone (334) 222-1211

847 W Bypass
Ste A
Andalusia, AL 36420
Phone (334) 222-1366

Interoperability endpoints

  • Direct secure messaging: cuf7690@yourcarecommunity.org
  • FHIR API: https://api.platform.athenahealth.com/19364/brand/1/csg/21/fhir/r4
  • Direct secure messaging: robert.long.1@19364.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1356317002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2234 COLONIAL BLVD",
            "address_2": "MANAGED CARE DEPT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071412",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 MAR WALT DR",
            "address_2": "SUITE 1011",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476635",
            "telephone_number": "850-863-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "ROBERT",
        "middle_name": "LAWRENCE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME0043999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "382563",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "1193377",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00728665",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "47173",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.