NPIMap

Organization Active NPI

Albany County

  • Land Ambulance
  • Clarksville, NY
National Provider Identifier
1356570592
Registry record updated Jan 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
6229 Issued in NY
Legal business name
ALBANY COUNTY
Practice address
58 Verda Ave
Clarksville, NY 12041
Phone
(518) 655-7846
Fax
(518) 655-7707
NPI assigned
Jul 9, 2009
Last updated
Jan 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2018

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

Authorized official

Name
Brian Wood
Title
Captain
Phone
(518) 655-7846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 6229 NY Primary

Addresses

Primary practice location

58 Verda Ave
Clarksville, NY 12041

Mailing address

PO Box 315
Voorheesville, NY 12186
Phone (518) 655-7846

Other names 1

  • Sheriff's Office EMS Unit Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100803000271 NY Part B Supplier - Ambulance Service Supplier 8224941331 Practice locations: Clarksville, NY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shaker Place Rehabiliation and Nursing CenterAlbany, NY, CCN 335425 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1970
Jul 1, 1970

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1356570592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 315",
            "city": "VOORHEESVILLE",
            "state": "NY",
            "postal_code": "12186",
            "telephone_number": "518-655-7846",
            "fax_number": "518-655-7707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 VERDA AVE",
            "city": "CLARKSVILLE",
            "state": "NY",
            "postal_code": "12041",
            "telephone_number": "518-655-7846",
            "fax_number": "518-655-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBANY COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "518-655-7846"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NY",
            "license": "6229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sheriff's Office EMS Unit",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clarksville, NY

Sources for this page

Verify at the official NPI Registry.