Medstar Ambulance Inc – Land Ambulance in Sparta, IL

Key facts

NPI: 1013900364
Entity type: Organization (NPI type 2)
Primary specialty: Land Ambulance 3416L0300X
License: 44837 (IL)
Legal business name: MEDSTAR AMBULANCE INC
Practice address: 705 Bradbury LN
Sparta, IL 62286-2102
Phone: (618) 443-5061
Fax: (618) 443-3897
NPI assigned: Aug 23, 2005
Organization subpart: No

Authorized official

Name: Deborah D Kelley
Title: Humanresources Manager
Phone: (618) 443-5061

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Matthew Gerdes Paramedic · Sparta, IL · NPI 1639533391

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040422000960	IL	Part B Supplier - Ambulance Service Supplier	1456347699	Practice locations: Chester, IL; Steeleville, IL; Sparta, IL; Scott Air Force Base, IL; Red Bud, IL; Madison, IL; Freeburg, IL; E St Louis, IL…

National Provider Directory

Locations

610 E Main St
Belleville, IL 62220

113 Water St
Cahokia Heights, IL 62206

3701 Falling Springs Rd
Cahokia Heights, IL 62206

1070 Franklin St
Carlyle, IL 62231

1600 Oak St
Chester, IL 62233

5301 Caseyville Ave
East Saint Louis, IL 62204
Phone (618) 482-5264

3505 Mississippi Ave
East Saint Louis, IL 62206
Phone (618) 332-1467

1510 N 89th St
Fairview Heights, IL 62208
Phone (618) 398-7007

4 E White St
Freeburg, IL 62243

312 W Saint Louis St
Lebanon, IL 62254

125 Braun St
Red Bud, IL 62278

315 E Church St
Sparta, IL 62286

1601 N Market St
Sparta, IL 62286
Phone (618) 413-5061

705 Bradbury Ln
Sparta, IL 62286
Phone (618) 443-5061

402 W Shawneetown Trl
Steeleville, IL 62288

1209 N Illinois St
Rear
Swansea, IL 62226
Phone (618) 222-1848

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Land Ambulance	3416L0300X	44837	IL	Yes

Addresses

Primary practice location

705 Bradbury LN
Sparta, IL 62286-2102

Mailing address

PO Box 296
Sparta, IL 62286-0296
Phone (618) 443-5061

Other identifiers

Identifier	Type	Issuer
088141300	Other	FEDERAL BLACK LUNG
133392100	Other	AWCE/DEPT OF LABOR
154099XX	Other	PREFERRED CARE
0007915009	Other	BCBS
133392100	Other	HEALTHCARE USA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 8, 2026.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778198400000",
    "number": "1013900364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 296",
            "city": "SPARTA",
            "state": "IL",
            "postal_code": "622860296",
            "telephone_number": "618-443-5061",
            "fax_number": "618-443-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 BRADBURY LN",
            "city": "SPARTA",
            "state": "IL",
            "postal_code": "622862102",
            "telephone_number": "618-443-5061",
            "fax_number": "618-443-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAR AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "HUMANRESOURCES MANAGER",
        "authorized_official_telephone_number": "618-443-5061"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "44837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "088141300",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AWCE/DEPT OF LABOR",
            "identifier": "133392100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "154099XX",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0007915009",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA",
            "identifier": "133392100",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, IL

All providers in Sparta, IL · Land Ambulance in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2026. 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.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.