Amy De Long, MD MPH
Individual provider Active NPI Family Medicine Physician · Baraboo, WI
NPI 1932278090 · NPPES record last updated Feb 1, 2022
Key facts
- NPI
- 1932278090
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 44246 (WI)
- Practice address
- S2845 White Eagle Lane
Baraboo, WI 53913 - Phone
- (608) 355-1240
- Fax
- (608) 356-6347
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ho Chunk Nation
Practice addresses (Care Compare)
S2845 White Eagle Rd
Baraboo, WI 53913-9064
Phone (608) 355-1240
Hospital & facility affiliations
- University of Wi Hospitals & Clinics Authority
- SSM Health St Clare Hospital - Baraboo
- Reedsburg Area Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040728000833 | WI | Practitioner - Family Practice | 8426028390 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44246 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ho-Chunk Nation | Current |
Accepting new patients | |
| Ho Chunk Nation | Current |
Accepting new patients | |
| Dean Health Systems, Inc, | Past | Accepting new patients |
Locations
S2845 White Eagle Rd
Baraboo, WI 53913
Phone (608) 355-1240
N6520 Lumberjack Guy Rd
Blk River Fls, WI 54615
Phone (715) 284-9851
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 44246 | WI | Yes |
Addresses
Primary practice location
S2845 White Eagle Lane
Baraboo, WI 53913
Mailing address
S2845 White Eagle Lane
Baraboo, WI 53913
Phone (608) 355-1240
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34508300 | Medicaid | WI | |
| 0012 | Other | WI | WPS STATE PART B |
Other names
- Amy Du Bray
Other providers in Baraboo, WI
- County of Sauk
- Karen L. Crook
- Laura Daley
- James R Damos
- Kate Elizabeth Darnell
- Dean Health Systems, Inc,
- Dean Health Systems, Inc.
- Dean Health Systems, Inc.
- Dean Retail Services, Inc.
- Ashley Deblois
All providers in Baraboo, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.