Active NPI
City of Jefferson
- Land Ambulance
- Jefferson, WI
National Provider Identifier
1770697153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- CITY OF JEFFERSON
- Practice address
- 351 E Racine St
Jefferson, WI 53549-1648 - Phone
- (920) 674-2751
- NPI assigned
- Aug 19, 2006
- 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
- Susan Reinen
- Title
- EMS Director
- Phone
- (920) 674-2751
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
351 E Racine St
Jefferson, WI 53549-1648
Mailing address
PO Box 547
Wheeling, IL 60090-0547
Phone (847) 305-5236
Other names 1
- JEFFERSON EMS
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090611000724 | WI | Part B Supplier - Ambulance Service Supplier | 3375693302 | Practice locations: Jefferson, WI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0989084 | Jefferson EMS | Certificate of waiver | Jul 16, 2027 |
National Provider Directory
National Provider DirectoryLocations
121 W Racine St
Jefferson, WI 53549
Phone (920) 674-2751
351 E Racine St
Jefferson, WI 53549
Phone (920) 674-2751
317 S Main St
Jefferson, WI 53549
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1738108800000",
"number": "1770697153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 547",
"city": "WHEELING",
"state": "IL",
"postal_code": "600900547",
"telephone_number": "847-305-5236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 E RACINE ST",
"city": "JEFFERSON",
"state": "WI",
"postal_code": "535491648",
"telephone_number": "920-674-2751"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CITY OF JEFFERSON",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-19",
"last_updated": "2025-01-29",
"certification_date": "2025-01-29",
"status": "A",
"authorized_official_last_name": "REINEN",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "EMS DIRECTOR",
"authorized_official_telephone_number": "920-674-2751"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "JEFFERSON EMS",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Jefferson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.