Individual provider Active NPI

Kevin R. Long, A.R.N.P.

  • Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1992759740
Registry record updated Aug 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP2869582 Issued in FL
Practice address
1824 King St Ste 300
Jacksonville, FL 32204
Phone
(904) 388-1820
Fax
(904) 388-1827
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP2869582 FL Primary

Addresses

Primary practice location

1824 King St Ste 300
Jacksonville, FL 32204

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (904) 296-5691

Other identifiers 1

IdentifierTypeStateIssuer
012160200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20050622001040 FL Practitioner - Nurse Practitioner 5890730618 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Trauma Services LLCGroup PAC ID 3971985938, 92 clinicians

Practice addresses (Care Compare)

1887 Kingsley Ave
Suite 1900
Orange Park, FL 32073-4451
Phone (904) 276-2549

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Aug 1, 2018 Accepting new patients
Florida Trauma Services, LLC CurrentSince Jun 20, 2023 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Aug 1, 2018 Accepting new patients
Solantic LLC Past Accepting new patients

Locations

1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610

1824 King St
Ste 300
Jacksonville, FL 32204
Phone (904) 381-9393

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

4205 Belfort Rd
Ste 2069
Jacksonville, FL 32216
Phone (904) 296-0278

905 Beach Blvd
Jax Bch, FL 32250
Phone (904) 241-8300

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

1887 Kingsley Ave
Ste 1900
Orange Park, FL 32073
Phone (904) 272-9981

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 4

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 1

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533772800000",
    "number": "1992759740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-296-5691",
            "fax_number": "904-450-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 KING ST STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32204",
            "telephone_number": "904-388-1820",
            "fax_number": "904-388-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "KEVIN",
        "middle_name": "R.",
        "credential": "A.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2018-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP2869582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012160200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.