Active NPI
Braceville Fire Protection District
- Land Ambulance
- Braceville, IL
National Provider Identifier
1447344866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 77115
- Legal business name
- BRACEVILLE FIRE PROTECTION DISTRICT
- Practice address
- 102 Main St.,
Braceville, IL 60407 - Phone
- (815) 237-8682
- Fax
- (815) 237-8720
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 21, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Randy J. Berry
- Title
- Trustee/Treasurer
- Phone
- (815) 274-3653
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 77115 | IL | Primary |
Addresses
Primary practice location
102 Main St.,
Braceville, IL 60407
Mailing address
102 Main St., Box 237
Braceville, IL 60407
Phone (815) 237-8682
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 364366065001 | Medicaid | IL | |
| 03232037 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140527001015 | IL | Part B Supplier - Ambulance Service Supplier | 0840413597 | Practice locations: Braceville, IL |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1405900800000",
"number": "1447344866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 MAIN ST., BOX 237",
"city": "BRACEVILLE",
"state": "IL",
"postal_code": "60407",
"telephone_number": "815-237-8682",
"fax_number": "815-237-8720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 MAIN ST.,",
"city": "BRACEVILLE",
"state": "IL",
"postal_code": "60407",
"telephone_number": "815-237-8682",
"fax_number": "815-237-8720"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRACEVILLE FIRE PROTECTION DISTRICT",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-02",
"last_updated": "2014-07-21",
"status": "A",
"authorized_official_last_name": "BERRY",
"authorized_official_first_name": "RANDY",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "TRUSTEE/TREASURER",
"authorized_official_telephone_number": "815-274-3653",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "IL",
"license": "77115",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "364366065001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "03232037",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Braceville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.