Active NPI
Thomas James Longwill, DDS
- General Practice Dentistry
- Roswell, NM
National Provider Identifier
1689676017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1528
- Practice address
- 306 W Tilden St
Roswell, NM 88203-4544 - Phone
- (575) 623-3204
- Fax
- (575) 625-2071
- NPI assigned
- Aug 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1528 | NM | Primary |
Addresses
Primary practice location
306 W Tilden St
Roswell, NM 88203-4544
Mailing address
306 W Tilden St
Roswell, NM 88203-4544
Phone (575) 623-3204
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0016994 | Medicaid | NM | |
| 851955 | Other | NM | PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160127001343 | NM | Order and Referring Only - Dentist | 6305149295 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1528 | NM | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1689676017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 W TILDEN ST",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882034544",
"telephone_number": "575-623-3204",
"fax_number": "575-625-2071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 W TILDEN ST",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882034544",
"telephone_number": "575-623-3204",
"fax_number": "575-625-2071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGWILL",
"first_name": "THOMAS",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-15",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NM",
"license": "1528",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0016994",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER ID",
"identifier": "851955",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.