Active NPI
Jeffrey Neil Longenecker, PA-C
- Surgical Physician Assistant
- Athens, TN
National Provider Identifier
1609024140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 1114 W Madison Ave
Athens, TN 37303-4150 - Phone
- (423) 744-3308
- Fax
- (423) 744-3495
- NPI assigned
- Sep 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1655 | TN | |
| Medical Physician Assistant | 363AM0700X | 1655 | TN | |
| Surgical Physician Assistant | 363AS0400X | TN | Primary |
Addresses
Primary practice location
1114 W Madison Ave
Athens, TN 37303-4150
Mailing address
5016 Lewis Rd
MC Donald, TN 37353-4069
Phone (615) 829-3949
Other practice location 1
2400 Patterson St
Suite 300
Nashville, TN 37203-1562
Phone (615) 342-6300
Other practice location 2
9400 Rhea County Hwy
Dayton, TN 37321-7922
Phone (423) 775-1121
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3665294 | Medicaid | TN | |
| 4204068 | Other | TN | BCBS |
| 4204066 | Other | TN | BSBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN, GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1655 | TN | MD | Marriage & Family Therapist |
| 11631 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sweetwater Hospital Association | Current | Accepting new patients | |
| Chattanooga Emergency Medicine PLLC | Current | Accepting new patients | |
| Sweetwater Hospital ER Physician Group | Current | Accepting new patients | |
| Sweetwater Hospital Association | Physician Assistant | Past | Accepting new patients |
Locations
2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620
304 Church St
Sweetwater, TN 37874
Phone (865) 213-8200
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/sweet-8feb766f
Organizations & group practices 10
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.
-
- Emergency Care Clinic/Center
- Hixson, TN
- NPI 1427264126
-
- Nurse Practitioner
- Lawrenceburg, TN
- NPI 1053351593
-
- Nurse Practitioner
- Athens, TN
- NPI 1669414264
-
- Certified Registered Nurse Anesthetist
- Sweetwater, TN
- NPI 1629077532
-
- Emergency Medicine Physician
- Hardinsburg, KY
- NPI 1346746385
TN
-
- Rural Health Clinic/Center
- Sweetwater, TN
- NPI 1205659711
-
- Emergency Medicine Physician
- Sweetwater, TN
- NPI 1083613905
-
- Obstetrics & Gynecology Physician
- Sweetwater, TN
- NPI 1558995399
Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1609024140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5016 LEWIS RD",
"city": "MC DONALD",
"state": "TN",
"postal_code": "373534069",
"telephone_number": "615-829-3949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 W MADISON AVE",
"city": "ATHENS",
"state": "TN",
"postal_code": "373034150",
"telephone_number": "423-744-3308",
"fax_number": "423-744-3495"
}
],
"practiceLocations": [
{
"address_1": "2400 Patterson St",
"address_2": "Suite 300",
"address_purpose": "LOCATION",
"city": "Nashville",
"state": "TN",
"postal_code": "372031562",
"country_code": "US",
"telephone_number": "615-342-6300",
"fax_number": "615-342-6350",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9400 Rhea County Hwy",
"address_purpose": "LOCATION",
"city": "Dayton",
"state": "TN",
"postal_code": "373217922",
"country_code": "US",
"telephone_number": "423-775-1121",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LONGENECKER",
"first_name": "JEFFREY",
"middle_name": "NEIL",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-08",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "1655",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TN",
"license": "1655",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3665294",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "4204068",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSBS",
"identifier": "4204066",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Athens, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.