Organization Active NPI

Mission Care of Illinois, LLC

  • Ambulance
  • Benton, IL
National Provider Identifier
1548526932
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
Legal business name
MISSION CARE OF ILLINOIS, LLC
Doing business as
Abbott EMS
Practice address
137 Industrial Park Rd
Benton, IL 62812-4541
Phone
(314) 768-1212
NPI assigned
Apr 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Authorized official

Name
Brian Scott Tierney
Title
Evp, Chief Financial Officer
Phone
(833) 703-2294

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X Primary
Land Ambulance 3416L0300X

Addresses

Primary practice location

137 Industrial Park Rd
Benton, IL 62812-4541

Mailing address

PO Box 847199
Dallas, TX 75284-7199
Phone (800) 913-9106

Other names 1

  • Abbott EMS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041207000484 IL Part B Supplier - Ambulance Service Supplier 3375509896 2 other NPIs on this enrollment
Practice locations: Belleville, IL; Shelbyville, IL; Mattoon, IL; Benton, IL; Decatur, IL

Other NPIs on the same Medicare enrollment 2

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

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
14D2037815Mission Care of Illinois, L L C137 Industrial Park Rd, Benton, IL 62812Certificate of waiverMar 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Mission Care of Illinois LLC3 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

25 Royal Heights Ctr
Belleville, IL 62226
Phone (618) 233-4820

4400 N Belt W
Unit B
Belleville, IL 62226
Phone (618) 233-4820

301 E Park St
Benton, IL 62812
Phone (618) 435-3103

137 Industrial Park Rd
Benton, IL 62812
Phone (314) 768-1212

1209 N Wenthe Dr
Ste C
Effingham, IL 62401
Phone (618) 219-5418

219 N Cedar St
Shelbyville, IL 62565
Phone (217) 765-0285

NPI Registry JSON

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1548526932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847199",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847199",
            "telephone_number": "800-913-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 INDUSTRIAL PARK RD",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628124541",
            "telephone_number": "314-768-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CARE OF ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "TIERNEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "EVP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "833-703-2294"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Abbott EMS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Abbott EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.