Randy J. Long, PA-C, FAPACUS

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-00793 Issued in KS

Practice address

9350 E. 35TH Street North
Suite 104
Wichita, KS 67226

Phone

(316) 616-6272

Fax

(316) 858-7085

NPI assigned

Nov 2, 2006

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Eleven-Twelve Company

  • Cardiovascular Disease Physician
  • Wichita, KS
  • NPI 1831310119
  NPD (past)
• Mid America Surgical Associates

  • Surgery Physician
  • Wichita, KS
  • NPI 1710948906
  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264636800000",
    "number": "1366520686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9350 E. 35TH STREET NORTH",
            "address_2": "SUITE 104",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67226",
            "telephone_number": "316-616-6272",
            "fax_number": "316-616-0407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9350 E. 35TH STREET NORTH",
            "address_2": "SUITE 104",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67226",
            "telephone_number": "316-616-6272",
            "fax_number": "316-858-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "RANDY",
        "middle_name": "J.",
        "credential": "PA-C, FAPACUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2010-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1500793",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-00793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100402610B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2004260304",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "426953",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Long, D.C.
• Cydnee Bacci Long, OTR
• Jodie N Long, PTA
• Kimberly Bick Long, APRN
• Matt Long
• Amanda Sue Longoria, OD
• Christina J Longyear
• Colleen Loo-Gross
• Lydia CHI Loo, ARNP
• Jenna Lynn Loomis, AUD

• Physician Assistant in Wichita, KS
• Providers in Wichita, KS by specialty
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.