Mystic River Ambulance Association, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

MYSTIC RIVER AMBULANCE ASSOCIATION, INC

Practice address

237 Sandy Hollow Rd
Mystic, CT 06355-1617

Phone

(860) 572-0283

NPI assigned

Sep 20, 2005

Organization subpart

No

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

Authorized official

Name

Leo Todd McDonnell

Title

President

Phone

(860) 572-0283

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763424000000",
    "number": "1699760249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 165",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064050165",
            "telephone_number": "860-452-4500",
            "fax_number": "860-452-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 SANDY HOLLOW RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551617",
            "telephone_number": "860-572-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC RIVER AMBULANCE ASSOCIATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A",
        "authorized_official_last_name": "MCDONNELL",
        "authorized_official_first_name": "LEO TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-572-0283"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004116093",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590006767",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "710C137B1CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "CT0795",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mystic Medical Associates LLC
• Mystic Medical Group, PC
• Mystic Services, LLC
• Mystic Spine & Sport LLC
• Mystic Therapy, LLC.
• Mystic Westerly Orthodontics, PC
• Natura Medica

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; 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.