Stafford R Long, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA A10311 Issued in LA

Practice address

2751 Albert L Bicknell Dr
Suite 1-B
Shreveport, LA 71103-3920

Phone

(318) 212-8776

Fax

(318) 212-8774

NPI assigned

May 16, 2006

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

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Highland Emergency Group, LLC

  • Emergency Medicine Physician
  • Shreveport, LA
  • NPI 1154913861
  Medicare reassignment
• Sound Physicians Emergency Medicine of Louisiana Inc

  • Emergency Medicine Physician
  • Lake Charles, LA
  • NPI 1396253407
  Medicare reassignment
• Texas Trail Emergency Physicians LLC

  • Emergency Medicine Physician
  • Shreveport, LA
  • NPI 1902052301
  NPD (past)
• Velocity MD LLC

  dba Velocity Care

  • Urgent Care Clinic/Center
  • Shreveport, LA
  • NPI 1255680724
  NPD (past)
• WK North Orthopedic Clinic

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Shreveport, LA
  • NPI 1306823596
  NPD (past)
• Longview Emergency Medicine Associates PLLC

  • Emergency Medicine Physician
  • Marshall, TX
  • NPI 1902930589

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1851343396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2751 ALBERT L BICKNELL DR",
            "address_2": "SUITE 1-B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033920",
            "telephone_number": "318-212-8776",
            "fax_number": "318-212-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2751 ALBERT L BICKNELL DR",
            "address_2": "SUITE 1-B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033920",
            "telephone_number": "318-212-8776",
            "fax_number": "318-212-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "STAFFORD",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.A10311",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "PA A10311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1722928",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brianna London Duron, PASTORAL COUNSELOR
• Steve Norman London, M.D.
• Ciera Long
• Kelsey Long
• Mitsi Tonette Long, PMHNP
• Shawna Marie Longoria, FNP
• Look Eyecare LLC
• Yair J Lopez Torres, MD
• Arturo Lopez, MD
• Christen Necole Lopez, R.T. (R)

• Surgical Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Surgical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; 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.

Verify at the official NPI Registry.