DYMOND LONG (APN, FNP-BC) – Family Nurse Practitioner, NPI 1114463049
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,703 NURSE PRACTITIONER in IL
Provider Addresses for DYMOND LONG (APN, FNP-BC)
22930 LAKESHORE DR
RICHTON PARK, IL 604712324
Phone: (708) 506-6440
Fax: (773) 564-3515
Type: Mailing
PO BOX 746715
ATLANTA, GA 303746715
Phone: (773) 352-1515
Fax: (312) 929-0373
Type: Mailing
17730 Oak Park Ave Ste B
Tinley Park, IL 604772065
Phone: (708) 998-5542
Fax: (708) 377-3940
Type: Location
1709-1715, East 95th Street, Stony Island, South Deering, Chicago, Hyde Park Township, Cook County, Illinois, 60617, United States
CHICAGO, IL 606174708
Phone: (773) 768-4437
Fax: (773) 564-3515
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-01-12
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180112000180 | I | Nurse Practitioner | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 78 | 57 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 19 | 19 | $0 |
Insurance plans in this area (ZIP 60471)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P O D I A T R Y | IL | |
| Nurse Practitioner | IL | |
| - | IL | |
| - | PA | |
| - | IL | |
| Family Practice | GA | |
| Nurse Practitioner | GA | |
| Nurse Practitioner | IL | |
| Family Practice | IN | |
| - | IL |
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