City of Portage

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0066 Issued in IN

Legal business name

CITY OF PORTAGE

Doing business as

Portage Fire Department Ambulance

Practice address

3401 Swanson Rd
Portage, IN 46368-4822

Phone

(219) 762-7784

Fax

(219) 763-9607

NPI assigned

Mar 29, 2007

Last updated

Mar 1, 2024By 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

Roy Johnson

Title

EMS Chief of Operations

Phone

(219) 707-7711

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Portage Fire Department Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1306965223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2122",
            "city": "RIVERVIEW",
            "state": "MI",
            "postal_code": "481931122",
            "telephone_number": "800-926-6985",
            "fax_number": "734-479-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 SWANSON RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684822",
            "telephone_number": "219-762-7784",
            "fax_number": "219-763-9607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PORTAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "EMS CHIEF OF OPERATIONS",
        "authorized_official_telephone_number": "219-707-7711"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM INSURANCE COMP",
            "identifier": "000000234636",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100271470A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAMETTO RAILROAD MEDICARE",
            "identifier": "590164506",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portage Fire Department Ambulance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Portage Fire Department Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gabrielle Marie Chandler, DNP,CNM
• Nora Charles
• Chhabra Medical Corporation PC
• Christopher Chiappetta, DDS
• Jaekyung Jacey Cho, ARNP
• Joanna Claussen, APRN
• Jennifer E Cobb, PTA
• Samantha Cochran, ATC, LAT
• Rebecca Colbert
• Abby Collyard

• Land Ambulance in Portage, IN
• Providers in Portage, IN by specialty
• Land Ambulance in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.