Individual provider Active NPI

Zachary James Long, MD

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1669977104
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.156666 Issued in IL
Practice address
3245 N Halsted St
Chicago, IL 60657-3419
Phone
(773) 388-1600
Fax
(773) 388-8936
NPI assigned
Mar 27, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.156666 IL Primary

Addresses

Primary practice location

3245 N Halsted St
Chicago, IL 60657-3419

Mailing address

3421 Northview Dr
Jackson, MS 39216-3112
Phone (601) 927-8822

Other practice location 1

4600 N Ravenswood Ave
Chicago, IL 60640-4510
Phone (773) 561-7500

Other identifiers 2

IdentifierTypeStateIssuer
036156666MedicaidIL
036156666OtherILSTATE LICENSE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210813001197 IL Practitioner - Family Practice 4284038100 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

5346 N Clark St
The Clark
Chicago, IL 60640-2120
Phone (773) 293-8880

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010
  • Swedish Hospital Hospital, Chicago, IL, CCN 140114

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Brown Health Center CurrentSince Jul 6, 2021 Accepting new patients
Endeavor Health Medical Group CurrentSince Jun 19, 2024 Accepting new patients
Endeavor Health Medical Group Family Medicine Current Accepting new patients
Howard Brown Health Center CurrentSince Jul 6, 2021 Accepting new patients
Howard Brown Health Center Current Accepting new patients
Howard Brown Health Center Past Accepting new patients

Locations

3245 N Halsted St
Chicago, IL 60657
Phone (773) 296-8400

4025 N Sheridan Rd
Chicago, IL 60613
Phone (773) 388-1800

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1669977104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 NORTHVIEW DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392163112",
            "telephone_number": "601-927-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573419",
            "telephone_number": "773-388-1600",
            "fax_number": "773-388-8936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4600 N Ravenswood Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606404510",
            "country_code": "US",
            "telephone_number": "773-561-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "ZACHARY",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-27",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.156666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036156666",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036156666",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.