NPIMap

Organization Active NPI

Pendleton Emergency Ambulance Inc

  • Land Ambulance
  • Pendleton, IN
National Provider Identifier
1518019637
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
EMS COMM CERT 0041 Issued in IN
Legal business name
PENDLETON EMERGENCY AMBULANCE INC
Practice address
100 S Broadway
Pendleton, IN 46064
Phone
(765) 778-2400
NPI assigned
Jan 17, 2007
Last updated
Sep 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Authorized official

Name
Mr. George M Gasparovic
Title
Treasurer
Phone
(317) 775-6753

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X EMS COMM CERT 0041 IN Primary

Addresses

Primary practice location

100 S Broadway
Pendleton, IN 46064

Mailing address

PO Box 56002
Indianapolis, IN 46256-0002
Phone (317) 775-6753

Other identifiers 3

IdentifierTypeStateIssuer
590000389OtherPALMETTOGBA RR MEDICARE
000000187430OtherANTHEM
100281760AMedicaidIN

Other names 1

  • Indiana Non Profit Organization Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1518019637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 56002",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462560002",
            "telephone_number": "317-775-6753",
            "fax_number": "765-778-7287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S BROADWAY",
            "city": "PENDLETON",
            "state": "IN",
            "postal_code": "46064",
            "telephone_number": "765-778-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDLETON EMERGENCY AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "GASPAROVIC",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "317-775-6753",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "EMS COMM CERT 0041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTOGBA RR MEDICARE",
            "identifier": "590000389",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000187430",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100281760A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Non Profit Organization",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Indiana Non Profit Organization",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pendleton, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.