NPIMap

Organization Active NPI

Portsmouth Emergency Ambulance Service Inc

  • Land Ambulance
  • South Shore, KY
National Provider Identifier
1487092862
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
1676 Issued in KY
Legal business name
PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC
Practice address
186 Hauser Ave
South Shore, KY 41175
Phone
(740) 354-3122
Fax
(740) 351-0679
NPI assigned
Jun 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Authorized official

Name
Rachael Estep
Title
Administration
Phone
(740) 354-3122

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 1676 / 1677 KY
Land Ambulance 3416L0300X
Land Ambulance 3416L0300X 1676 KY Primary
Land Ambulance 3416L0300X 1677 KY
Non-emergency Medical Transport (VAN) 343900000X
Non-emergency Medical Transport (VAN) 343900000X 1676 KY
Non-emergency Medical Transport (VAN) 343900000X 1677 KY

Addresses

Primary practice location

186 Hauser Ave
South Shore, KY 41175

Mailing address

2796 Gallia Street
Portsmouth, OH 45662
Phone (740) 354-3122

Other identifiers 8

IdentifierTypeStateIssuer
0096759MedicaidOH
1487092862OtherKYKY MEDICARE PROVIDER NUMBER K093870
7100189640MedicaidKY
7100260300MedicaidKY
3159442MedicaidOH
7100174460MedicaidKY
7100260270MedicaidKY
96759MedicaidOH

Other names 1

  • PEASI Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130715000739 KY Part B Supplier - Ambulance Service Supplier 4587841028 Practice locations: Ashland, KY; Portsmouth, OH; South Shore, KY

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Portsmouth Emergency Ambulance Service Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

421 Mound Cemetery Rd
Piketon, OH 45661
Phone (740) 289-3990

NPI Registry JSON

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1487092862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2796 GALLIA STREET",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "45662",
            "telephone_number": "740-354-3122",
            "fax_number": "740-351-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 HAUSER AVE",
            "city": "SOUTH SHORE",
            "state": "KY",
            "postal_code": "41175",
            "telephone_number": "740-354-3122",
            "fax_number": "740-351-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTSMOUTH EMERGENCY AMBULANCE SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-07",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "ESTEP",
        "authorized_official_first_name": "RACHAEL",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "740-354-3122"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "KY",
            "license": "1676 / 1677",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "KY",
            "license": "1676",
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "KY",
            "license": "1677",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "KY",
            "license": "1676",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "KY",
            "license": "1677",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0096759",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY MEDICARE PROVIDER NUMBER K093870",
            "identifier": "1487092862",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100189640",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100260300",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3159442",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100174460",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100260270",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96759",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEASI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PEASI",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "PEASI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in South Shore, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.