NPIMap

Organization Active NPI

Air Evac EMS, Inc.

Doing business as Air Evac Lifeteam

  • Air Ambulance
  • Olney, IL
National Provider Identifier
1104338425
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Air AmbulanceTaxonomy code 3416A0800X
Legal business name
AIR EVAC EMS, INC.
Doing business as
Air Evac Lifeteam
Practice address
3666 N Il 130
Olney, IL 62450-4741
Phone
(877) 288-5340
Fax
(417) 257-5761
NPI assigned
Oct 26, 2017
Last updated
Sep 26, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
AIR EVAC EMS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Authorized official

Name
Eric Thomas
Title
SVP of Revenue Management
Phone
(877) 288-5340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Air Ambulance 3416A0800X Primary

Addresses

Primary practice location

3666 N Il 130
Olney, IL 62450-4741

Mailing address

PO Box 106
West Plains, MO 65775-0106
Phone (877) 288-5340

Other names 1

  • Air Evac Lifeteam Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000107 IL Part B Supplier - Ambulance Service Supplier 8123931755 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Vernon, IL; Watson, IL; Quincy, IL; Olney, IL; Mattoon, IL; Marion, IL; Maryville, IL; Greenville, IL…

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2147345Air Evac Lifeteam - Ael 150 Olney Il3666 N Il 130, Olney, IL 62450Certificate of waiverApr 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lifeteam Midwest Ae20162 organizations share this tax ID, including this one
Part of
Lifeteam Midwest Ae20

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1508976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1104338425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 106",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657750106",
            "telephone_number": "877-288-5340",
            "fax_number": "417-257-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3666 N IL 130",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624504741",
            "telephone_number": "877-288-5340",
            "fax_number": "417-257-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AIR EVAC EMS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AIR EVAC EMS, INC.",
        "enumeration_date": "2017-10-26",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "SVP OF REVENUE MANAGEMENT",
        "authorized_official_telephone_number": "877-288-5340"
    },
    "taxonomies": [
        {
            "code": "3416A0800X",
            "taxonomy_group": "",
            "desc": "Ambulance, Air Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Air Evac Lifeteam",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olney, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.