NPIMap

Individual provider Active NPI

Jackson Long, M.D.

  • Family Medicine Physician
  • Mount Pleasant, NC
National Provider Identifier
1487032827
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
210563 Issued in NC
Practice address
8560 Cook St
Mt Pleasant, NC 28124-7686
Phone
(704) 436-6521
Fax
(704) 436-9505
NPI assigned
May 18, 2015
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 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 210563 NC Primary

Addresses

Primary practice location

8560 Cook St
Mt Pleasant, NC 28124-7686

Mailing address

270 Copperfield Blvd NE Ste 202
Concord, NC 28025-2441
Phone (704) 721-2060

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jlong387313@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 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
I20180815001525 MN Practitioner - Family Practice 9931413705 Reassigns benefits to 1 organization
I20181016003078 WI Practitioner - Family Practice 9931413705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

1175 Nininger Rd
Hastings, MN 55033-1056
Phone (651) 404-1000

1629 E Division St
River Falls, WI 54022-1571
Phone (612) 262-1200

1687 E Division St
River Falls, WI 54022-1571
Phone (715) 307-6432

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
210563NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Aug 25, 2018 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System Family Medicine CurrentSince Jul 30, 2018 Accepting new patients
CMC Northeast Family Medicine Past Accepting new patients

Locations

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Organizations & group practices 5

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 40

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1487032827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 COPPERFIELD BLVD NE STE 202",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252441",
            "telephone_number": "704-721-2060",
            "fax_number": "704-789-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8560 COOK ST",
            "city": "MT PLEASANT",
            "state": "NC",
            "postal_code": "281247686",
            "telephone_number": "704-436-6521",
            "fax_number": "704-436-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JACKSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-18",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "210563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlong387313@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "8560 Cook St",
            "city": "MT Pleasant",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281247686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Pleasant, NC

Sources for this page

Verify at the official NPI Registry.