Jackie Long, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

16459 Issued in ND

Practice address

407 3Rd St SE
Minot, ND 58701-4470

Phone

(701) 857-2360

Fax

(701) 857-2187

NPI assigned

Nov 7, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, ND2 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

Specialty

Psychiatry

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Alexius Medical CenterGroup PAC ID 8426960865, 239 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002

Merit-based Incentive Payment System (MIPS)

Final score

81.05 of 100Reported as group

Quality

60.57

Promoting interoperability

98

Improvement activities

40

Cost

77.93

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St. Alexius Medical Center

  dba CHI St. Alexius Health Clinics

  • Specialist
  • Bismarck, ND
  • NPI 1205868429
  Medicare reassignment Care Compare group NPD
• Ascend Psychiatry & Wellness, PLLC

  • Psychiatry Physician
  • Maitland, FL
  • NPI 1083588081
  Medicare reassignment
• St Alexius Medical Center

  dba CHI St. Alexius Health

  • Home Infusion Therapy Pharmacy
  • Bismarck, ND
  • NPI 1063663607
  NPD
• St. Alexius Medical Center

  dba CHI St. Alexius Health

  • Psychiatric Hospital Unit
  • Bismarck, ND
  • NPI 1538220611
  NPD (past)
• Trinity Hospitals

  dba Trinity Hospitals Psych

  • Psychiatric Hospital Unit
  • Minot, ND
  • NPI 1417079211
  NPD (past)

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

• St. Alexius Medical Center

  dba CHI St. Alexius Health

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1306832654
  Care Compare affiliation

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1790039071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5010",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587025010",
            "telephone_number": "701-418-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 3RD ST SE",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014470",
            "telephone_number": "701-857-2360",
            "fax_number": "701-857-2187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13505 US Highway 1",
            "address_purpose": "LOCATION",
            "city": "Sebastian",
            "state": "FL",
            "postal_code": "329583759",
            "country_code": "US",
            "telephone_number": "772-257-8224 x339",
            "fax_number": "772-213-3157",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-418-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "JACKIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-07",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "16459",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME126295",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "ME126295",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brandon James Locke
• Eric Locken
• Dawn Lockrem
• Mary Elizabeth Logue, M.D.
• Orvin G. Lommen, LICSW
• Cassie Longnecker
• Richard Lothspeich
• Nicole Love, MS, ATC
• Heather Marie Lowe, LAC
• Jessica M Lucas, LAC

• Psychiatry Physician in Minot, ND
• Providers in Minot, ND by specialty
• Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.