NPIMap

Individual provider Active NPI

Kelly M Long, MD

  • Family Medicine Physician
  • Columbus, OH
National Provider Identifier
1366949539
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.141134 Issued in OH
Practice address
3555 Olentangy River Rd Ste 1080
Columbus, OH 43214-3984
Phone
(614) 268-8164
Fax
(614) 268-8406
NPI assigned
Apr 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.141134 OH Primary

Addresses

Primary practice location

3555 Olentangy River Rd Ste 1080
Columbus, OH 43214-3984

Mailing address

3555 Olentangy River Rd Ste 1080
Columbus, OH 43214-3984
Phone (614) 268-8164

Other identifiers 1

IdentifierTypeStateIssuer
0441066MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20210805001217 OH Practitioner - Family Practice 7618223066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Ohio Primary Care Physicians, Inc.Group PAC ID 2769383785, 487 clinicians

Practice addresses (Care Compare)

3555 Olentangy River Rd
Suite 1080
Columbus, OH 43214-3984
Phone (614) 268-8164

Hospital & facility affiliations

  • Mount Carmel St Ann'S Hospital, Westerville, OH, CCN 360012
  • Riverside Methodist Hospital Hospital, Columbus, OH, CCN 360006
  • Mount Carmel Dublin Hospital, Dublin, OH, CCN 360375
  • Mount Carmel New Albany Surgical Hospital Hospital, New Albany, OH, CCN 360266
  • Grant Medical Center Hospital, Columbus, OH, CCN 360017

Merit-based Incentive Payment System (MIPS)

Final score
87.04 of 100Reported as group
Quality
85.5
Improvement activities
40
Cost
83.38

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.141134OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Primary Care Physicians, Inc. CurrentSince Aug 9, 2021 Accepting new patients
Central Ohio Primary Care Physicians Inc Current Accepting new patients
Central Ohio Primary Care Physicians, Inc. Family Medicine CurrentSince Aug 9, 2021 Accepting new patients
Mount Carmel Health System Past Accepting new patients

Locations

3555 Olentangy River Rd
Ste 1080
Columbus, OH 43214
Phone (614) 268-8164

4885 Olentangy River Rd
Columbus, OH 43214
Phone (614) 326-5665

655 Africa Rd
Westerville, OH 43082

Interoperability endpoints

  • Direct secure messaging: klong18875@copcp.medicity.net

Organizations & group practices 4

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 6

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": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1366949539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 OLENTANGY RIVER RD STE 1080",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143984",
            "telephone_number": "614-268-8164",
            "fax_number": "614-268-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 OLENTANGY RIVER RD STE 1080",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143984",
            "telephone_number": "614-268-8164",
            "fax_number": "614-268-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KELLY",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-12",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.141134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0441066",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.