Three Rivers Ambulance Authority

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0114 Issued in IN

Legal business name

THREE RIVERS AMBULANCE AUTHORITY

Practice address

525 Hayden St
Fort Wayne, IN 46802-3550

Phone

(260) 420-6500

NPI assigned

Jul 1, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Joel Benz

Title

Executive Director

Phone

(260) 420-6500

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1861499139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11724",
            "address_2": "525 HAYDEN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468601724",
            "telephone_number": "260-420-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 HAYDEN ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468023550",
            "telephone_number": "260-420-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS AMBULANCE AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "BENZ",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "260-420-6500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE EMS PROVIDER CERT",
            "identifier": "0114",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100288230A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelley Thornton
• Pamela Thornton, PMHNP-BC
• Tara Thornton, PHARM D
• Allison A Thorpe, CNM
• Raja V Thotakura, M.D.
• Three Rivers Anesthesia, LLC
• Three Rivers Dermatology, LLC (Three Rivers Dermatology)
• Three Rivers Medical Associates, LLC
• Three Rivers Radiology, LLC
• Three Rivers Surgical Associates

• Land Ambulance in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Land Ambulance in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.