Lakeside EMS LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

060409935 Issued in IL

Legal business name

LAKESIDE EMS LLC

Doing business as

Lakeside EMS LLC

Practice address

815 S Maple St
Effingham, IL 62401-2641

Phone

(217) 994-2046

Fax

(724) 794-1633

NPI assigned

Apr 2, 2018

Last updated

Aug 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jerrod Estes

Title

Ceo/Paramedic

Phone

(217) 994-2046

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeside EMS LLC Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: jestes@lakesideems.com

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1093211823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 S MAPLE ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012641",
            "telephone_number": "217-994-2046",
            "fax_number": "724-794-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 S MAPLE ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624012641",
            "telephone_number": "217-994-2046",
            "fax_number": "724-794-1633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3293 E 500 North Rd",
            "address_purpose": "LOCATION",
            "city": "Neoga",
            "state": "IL",
            "postal_code": "62447",
            "country_code": "US",
            "telephone_number": "217-347-5367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15277 N 1000th St",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624017487",
            "country_code": "US",
            "telephone_number": "217-994-2046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE EMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-02",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A",
        "authorized_official_last_name": "ESTES",
        "authorized_official_first_name": "JERROD",
        "authorized_official_title_or_position": "CEO/PARAMEDIC",
        "authorized_official_telephone_number": "217-994-2046"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IL",
            "license": "060409935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "5219-01",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jestes@lakesideems.com",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "address_1": "815 S Maple St",
            "city": "Effingham",
            "state": "IL",
            "country_code": "US",
            "postal_code": "624012641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lakeside EMS LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bradley Steven Kuhns
• Shelly L Kuhns, APRN-FPA, CCNS
• Nitin Kumar, MD
• Laboratory Corporation of America
• Lakeland Rehabilitation and Healthcare Center, LLC (Lakeland Rehabilitation & Health Care Center)
• Jeffrey David Lakins, RPH
• Cheryl Lynn Lamb, N.P.
• Larry Lambert, M.D.
• Susan Lynn Lamonica, APRN
• Colleen M Lareau, LPC

• Land Ambulance in Effingham, IL
• Providers in Effingham, IL by specialty
• Land Ambulance in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare 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.