NPIMap

Organization Active NPI

Air Evac EMS, Inc.

Doing business as Air Evac Lifeteam

  • Air Ambulance
  • Fayetteville, GA
National Provider Identifier
1356980650
Registry record updated Jan 3, 2020
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
125 Promenade Pkwy
Fayetteville, GA 30214-7712
Phone
(877) 288-5340
Fax
(417) 257-5761
NPI assigned
Jan 3, 2020
Last updated
Jan 3, 2020By 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 Jan 3, 2020

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

125 Promenade Pkwy
Fayetteville, GA 30214-7712

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 GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040430000654 GA Part B Supplier - Ambulance Service Supplier 8123931755 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thomaston, GA; Waycross, GA; Vidalia, GA; Tifton, GA; Statesboro, GA; Snellville, GA; Perry, GA; Milledgeville, GA…

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
11D2177966Air Evac Lifeteam Ael 153125 Promenade Parkway, Fayetteville, GA 30214Certificate of waiverJan 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Air Evac EMS162 organizations share this tax ID, including this one
Part of
Air Evac EMS

Organizations with this tax ID in the same state 17

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

View all 17

Locations

125 Promenade Pkwy
Fayetteville, GA 30214
Phone (770) 881-7043

NPI Registry JSON

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

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1356980650",
    "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": "125 PROMENADE PKWY",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147712",
            "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": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "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 Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; 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.