Kelly Lynn Long, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601003518 Issued in MI

Practice address

500 Ross St
Plymouth, MI 48170-2206

Phone

(734) 341-7767

Fax

(734) 893-3131

NPI assigned

Jun 24, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Michigan Infusion Services and Licensed HealthcareGroup PAC ID 0840674321, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130
• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
• Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Michigan Infusion Services and Licensed Healthcare

  • Health Service Clinic/Center
  • Plymouth, MI
  • NPI 1164168126
  Medicare reassignment Care Compare group Authorized official
• Michigan Infusion and Licensed Healthcare

  • Physician Assistant
  • Plymouth, MI
  • NPI 1164153367
  NPD Authorized official
• International Therapy Solutions, PLLC

  • Clinical Social Worker
  • Warren, MI
  • NPI 1093254120
  Medicare reassignment
• Southeast Michigan Physicians Group

  • Specialist
  • Romulus, MI
  • NPI 1346695202
  Medicare reassignment

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

• St Joseph Mercy Hospital

  dba Trinity Heath Ann Arbor Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Troy

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Royal Oak

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Grosse Pointe

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1568623338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ROSS ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702206",
            "telephone_number": "734-341-7767",
            "fax_number": "734-893-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ROSS ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481702206",
            "telephone_number": "734-341-7767",
            "fax_number": "734-893-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KELLY",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN LICENSE",
            "identifier": "5601003518",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sophia Logan
• Daniel Edward Lohmeier, RPH
• Lynn A Lombardo, MA, LLP
• Kathleen Long, CNP
• Kathryn Long
• Look Within Counseling LLC
• Arleth Lopez
• Jessica Lopez
• Maria Lopez
• Elizabeth A Lorenz, LPC

• Medical Physician Assistant in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.