Individual provider Active NPI

Shawn E Long, M.D.

  • Family Medicine Physician
  • Oakland, MD
National Provider Identifier
1639275332
Registry record updated Apr 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0078630 Issued in MD
Practice address
1027 Memorial Dr
Oakland, MD 21550-4343
Phone
(301) 533-3300
Fax
(301) 533-3299
NPI assigned
Sep 16, 2006
Last updated
Apr 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20683 WV
Family Medicine Physician 207Q00000X D0078630 MD Primary

Addresses

Primary practice location

1027 Memorial Dr
Oakland, MD 21550-4343

Mailing address

1027 Memorial Dr
Oakland, MD 21550-4343
Phone (301) 533-3300

Other practice location 1

22221 Westernport Rd SW
Westernport, MD 21562-2206
Phone (240) 774-0204

Other practice location 2

104 Parkview Dr
Grantsville, MD 21536-1086
Phone (844) 652-8730

Other identifiers 2

IdentifierTypeStateIssuer
402362500MedicaidMD
2005302000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230809003812 PA Practitioner - Family Practice 0749250744 Reassigns benefits to 1 organization
I20231219000112 NY Practitioner - Family Practice 0749250744 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0078630MDMDFamily Medicine Physician
20683WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellbe Senior Medical Group of Pennsylvania PC CurrentSince Sep 11, 2023 Accepting new patients
Russo & Long Enterpirses Inc Current Accepting new patients
Wellbe New York Medical PC CurrentSince Jan 1, 2024 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Western Maryland Health Care Corporation Past Accepting new patients
West Virginia University Hospitals, Inc Past Accepting new patients

Locations

225 W Washington St
Ste 1500
Chicago, IL 60606
Phone (312) 776-2422

225 W Washington St
Ste 1700
Chicago, IL 60606
Phone (234) 200-4220

1156 6th Ave
New York, NY 10036
Phone (312) 776-2410

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1639275332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 MEMORIAL DR",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215504343",
            "telephone_number": "301-533-3300",
            "fax_number": "301-533-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 MEMORIAL DR",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215504343",
            "telephone_number": "301-533-3300",
            "fax_number": "301-533-3299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22221 Westernport Rd SW",
            "address_purpose": "LOCATION",
            "city": "Westernport",
            "state": "MD",
            "postal_code": "215622206",
            "country_code": "US",
            "telephone_number": "240-774-0204",
            "fax_number": "301-533-3299",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Parkview Dr",
            "address_purpose": "LOCATION",
            "city": "Grantsville",
            "state": "MD",
            "postal_code": "215361086",
            "country_code": "US",
            "telephone_number": "844-652-8730",
            "fax_number": "301-533-3299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "SHAWN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "20683",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0078630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402362500",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2005302000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, MD

Sources for this page

Verify at the official NPI Registry.