NPIMap

Organization Active NPI

Tim Long M.D., PSC

  • Primary Care Clinic/Center
  • Bowling Green, KY
National Provider Identifier
1417057902
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
TIM LONG M.D., PSC
Practice address
1320 Andrea St
Bowling Green, KY 42104-3334
Phone
(270) 746-5455
Fax
(270) 746-5688
NPI assigned
Sep 24, 2006
Last updated
Mar 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

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

Authorized official

Name
Dr. Timothy R. Long, M.D.NPI 1699743567
Title
President
Phone
(270) 746-5455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1320 Andrea St
Bowling Green, KY 42104-3334

Mailing address

1320 Andrea St
Bowling Green, KY 42104-3334
Phone (270) 746-5455

Other identifiers 3

IdentifierTypeStateIssuer
DA8524OtherMEDICARE RAILROAD
65936585MedicaidKY
000000216368OtherBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040802000733 KY Part B Supplier - Clinic/Group Practice 7810968104 Receives reassigned benefits from 5 practitioners
Practice locations: Bowling Green, KY

National Provider Directory

National Provider Directory

Locations

1320 Andrea St
Bowling Green, KY 42104
Phone (270) 746-5455

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1417057902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 ANDREA ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043334",
            "telephone_number": "270-746-5455",
            "fax_number": "270-746-5688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 ANDREA ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043334",
            "telephone_number": "270-746-5455",
            "fax_number": "270-746-5688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIM LONG M.D., PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-24",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-746-5455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DA8524",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65936585",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000000216368",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.