Individual provider Active NPI

Kathleen A Long, APRN-BC, ND

  • Family Nurse Practitioner
  • Mishawaka, IN
National Provider Identifier
1831113026
Registry record updated Jan 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71001562A Issued in IN
Practice address
420 W 4TH St
Mishawaka, IN 46544-1948
Phone
(574) 307-7673
Fax
(574) 307-7692
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71001562A IN Primary

Addresses

Primary practice location

420 W 4TH St
Mishawaka, IN 46544-1948

Mailing address

420 W 4TH St
Mishawaka, IN 46544-1948
Phone (574) 307-7673

Other identifiers 2

IdentifierTypeStateIssuer
200441170MedicaidIN
000000878026OtherINBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040303000936 IN Practitioner - Nurse Practitioner 5193612182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthlinc IncGroup PAC ID 7618929373, 83 clinicians

Practice addresses (Care Compare)

1001 Sturdy Rd
Valparaiso, IN 46383-4126
Phone 21946271732226

420 W 4TH St
Mishawaka, IN 46544-1948
Phone 57430776734693

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthlinc, Inc. CurrentSince Dec 25, 2014 Accepting new patients
Healthlinc, Inc CurrentSince Dec 25, 2014 Accepting new patients
Healthlinc, Inc. Current Accepting new patients
Saint Joseph Regional Medical Center, Inc. Past Accepting new patients
Saint Joseph Regional Medical Center, Inc. Family Past Accepting new patients

Locations

420 W 4th St
Mishawaka, IN 46544
Phone (574) 252-0300

1708 High St
South Bend, IN 46613
Phone (574) 237-6640

1001 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 462-7173

951 Transport Dr
Valparaiso, IN 46383
Phone (219) 464-4100

2401 Valley Dr
Valparaiso, IN 46383
Phone (219) 413-5100

Interoperability endpoints

  • Direct secure messaging: kathleen.long@healthlinc.directbygreenway.com

Organizations & group practices 5

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 4

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547683200000",
    "number": "1831113026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441948",
            "telephone_number": "574-307-7673",
            "fax_number": "574-307-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W 4TH ST",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441948",
            "telephone_number": "574-307-7673",
            "fax_number": "574-307-7692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "credential": "APRN-BC, ND",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2019-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71001562A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200441170",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000878026",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

Verify at the official NPI Registry.