Madison Ambulance Association Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

C076P1 Issued in CT

Legal business name

MADISON AMBULANCE ASSOCIATION INC

Practice address

9 Old Route 79
Madison, CT 06443-2604

Phone

(203) 245-9821

NPI assigned

Sep 19, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Samuel E. Deburra Jr.

Title

President

Phone

(203) 245-5617

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518739200000",
    "number": "1437144284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 ROUTE 80",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191400",
            "telephone_number": "860-663-3634",
            "fax_number": "860-663-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 OLD ROUTE 79",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432604",
            "telephone_number": "203-245-9821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON AMBULANCE ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2018-02-16",
        "status": "A",
        "authorized_official_last_name": "DEBURRA",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-245-5617",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "CT",
            "license": "C076P1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "CT0849",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590003585",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004084406",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "710C076P1CT01",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karl Michael Lussier, PHARM.D
• Marcie Lustgarten, OD LLC
• Lyblhealthsolutions LLC
• Wendy Mackey, APRN
• Greta E Macmillan, LCSW
• Madison Board of Education
• Madison Dental Spa
• Madison Eye Care LLC
• Madison Optical
• Madison Pediatrics LLC

• Land Ambulance in Madison, CT
• Providers in Madison, CT by specialty
• Land Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.