Individual provider Active NPI

Karriann Marie Longtin, APRN PMHNP CPNP-AC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bourbonnais, IL
National Provider Identifier
1629213624
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
277.002464 Issued in IL
Practice address
1482 Northfield Meadows Blvd
Bourbonnais, IL 60914-4612
Phone
(815) 592-3122
NPI assigned
Dec 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 277.002464 IL Primary

Addresses

Primary practice location

1482 Northfield Meadows Blvd
Bourbonnais, IL 60914-4612

Mailing address

1482 Northfield Meadows Blvd
Bourbonnais, IL 60914-4612
Phone (815) 592-3122

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20130626000170 IL Practitioner - Nurse Practitioner 7315186202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

755 Almar Pkwy
Bourbonnais, IL 60914-2392
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
277.002464ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Psychiatric/Mental Health CurrentSince Nov 1, 2023 Accepting new patients
Edgewood Clinical Services, P.C. Past Accepting new patients
Psychology Specialists LTD Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

755 Almar Pkwy
Ste A
Bourbonnais, IL 60914
Phone (815) 214-9079

755 Almar Pkwy
Bourbonnais, IL 60914
Phone (317) 366-9559

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

3027 English Rows Ave
Ste 201
Naperville, IL 60564

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.karriannlongtin@146897.advancedmd-direct.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1629213624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1482 NORTHFIELD MEADOWS BLVD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144612",
            "telephone_number": "815-592-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1482 NORTHFIELD MEADOWS BLVD",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144612",
            "telephone_number": "815-592-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGTIN",
        "first_name": "KARRIANN",
        "middle_name": "MARIE",
        "credential": "APRN PMHNP CPNP-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-05",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277.002464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

Verify at the official NPI Registry.