NPIMap

Individual provider Active NPI

Kellie Ann Longdon, MD

  • Emergency Medicine Physician
  • Sarasota, FL
National Provider Identifier
1740228683
Registry record updated Nov 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
P3920 Issued in TX
Practice address
2402 University Pkwy
Suite 106, BLDG. 1
Sarasota, FL 34243
Phone
(941) 355-4411
Fax
(941) 355-5511
NPI assigned
Jun 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME97009 FL
Emergency Medicine Physician 207P00000X P3920 TX Primary

Addresses

Primary practice location

2402 University Pkwy
Suite 106, BLDG. 1
Sarasota, FL 34243

Mailing address

2402 University Pkwy
Suite 106, BLDG. 1
Sarasota, FL 34243
Phone (941) 355-4411

Other identifiers 3

IdentifierTypeStateIssuer
347292001MedicaidTX
276635300MedicaidFL
8EA296OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
30682TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Inphynet Contracting Services LLC Emergency Medicine Past Accepting new patients
Advanced Pain Management Inc Past Accepting new patients
Aldrich Cardiovascular Institute PastSince Oct 29, 2018 Accepting new patients
Paragon Emergency Services LLC Emergency Medicine Past Accepting new patients
Acs Primary Care Physicians Louisiana PC Emergency Medicine Past Accepting new patients
Paragon Contracting Services LLC Emergency Medicine Past Accepting new patients
Island Medical SP LLC Emergency Medicine Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EADACD
  • Direct secure messaging: kellie.ann.longdon.1@13131.direct.athenahealth.com

Organizations & group practices 7

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": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448409600000",
    "number": "1740228683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 UNIVERSITY PKWY",
            "address_2": "SUITE 106, BLDG. 1",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "34243",
            "telephone_number": "941-355-4411",
            "fax_number": "941-355-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 UNIVERSITY PKWY",
            "address_2": "SUITE 106, BLDG. 1",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "34243",
            "telephone_number": "941-355-4411",
            "fax_number": "941-355-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGDON",
        "first_name": "KELLIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2015-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME97009",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "P3920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347292001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276635300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EA296",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.