NPIMap

Individual provider Active NPI

John Paul Long III, MD

  • Family Medicine Physician
  • Ada, OK
National Provider Identifier
1396195277
Registry record updated Sep 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2016018205 Issued in MO
Practice address
1921 Stonecipher Dr
Ada, OK 74820-3439
Phone
(580) 436-3980
Fax
(580) 421-4552
NPI assigned
Jun 21, 2016
Last updated
Sep 8, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2019

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 2016018205 MO Primary

Addresses

Primary practice location

1921 Stonecipher Dr
Ada, OK 74820-3439

Mailing address

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181126002030 MO Practitioner - Family Practice 4981958220 Reassigns benefits to 1 organization
I20190910001098 TX Practitioner - HospitalistPractitioner - Family Practice 4981958220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2016018205MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District Current Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Oct 1, 2018 Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Oct 1, 2018 Accepting new patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center CurrentSince Aug 15, 2019 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Aug 15, 2019 Accepting new patients

Locations

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Interoperability endpoints

  • Direct secure messaging: jlong21968@direct.chickasawnationhealth.net

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 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": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567900800000",
    "number": "1396195277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-436-3980",
            "fax_number": "580-421-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-436-3980",
            "fax_number": "580-421-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-21",
        "last_updated": "2019-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2016018205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.