Angela L Long, FNP
Individual provider Active NPI Family Nurse Practitioner · Swansea, IL
NPI 1639532609 · NPPES record last updated Apr 21, 2025
Key facts
- NPI
- 1639532609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209013742 (IL)
- Practice address
- 19 Wolf Creek Dr
Dept Otolaryngology
Swansea, IL 62226-2355 - Phone
- (618) 235-3687
- Fax
- (618) 239-9492
- NPI assigned
- Mar 29, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Washington University Physicians in Illinois Inc
Practice addresses (Care Compare)
19 Wolf Creek Dr
Swansea, IL 62226-2355
Phone (618) 235-3687
Hospital & facility affiliations
- HSHS St Elizabeth'S Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160603000047 | IL | Practitioner - Nurse Practitioner | 1557651544 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician Services Corporation of Southern Illinois Inc. | Current |
Accepting new patients | |
| Washington University Physicians in Illinois, Inc | Current |
Accepting new patients | |
| Washington University Physicians in Illinois, Inc | Current |
Accepting new patients |
Locations
400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221
7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155
2 Good Samaritan Way
Ste 320
Mount Vernon, IL 62864
Phone (618) 899-1944
4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750
19 Wolf Creek Dr
Swansea, IL 62226
Phone (618) 235-3687
4240 Duncan Ave
Ste 301
Saint Louis, MO 63110
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209013742 | IL | Yes |
Addresses
Primary practice location
19 Wolf Creek Dr
Dept Otolaryngology
Swansea, IL 62226-2355
Mailing address
PO Box 7412011
Chicago, IL 60674-2011
Phone (618) 235-3687
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 420078251 | Medicaid | MO |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ | Washington University |
Other providers in Swansea, IL
- Lifespine Center Inc.
- Kim Littlefield
- Live More Life LLC
- Libby Locke
- Cheryl Lynn Logston
- Lori a. Lehr, Ms, LCPC
- Brynne Luebbers
- M-Brace Birthing LLC
- Pamela Mack-Rainey
- Jeffrey Michael Maher
All providers in Swansea, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.