NPIMap

Organization Active NPI

Air Evac EMS, Inc.

Doing business as Air Evac Lifeteam

  • Air Ambulance
  • Carrollton, GA
National Provider Identifier
1891030201
Registry record updated Aug 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Air AmbulanceTaxonomy code 3416A0800X
Legal business name
AIR EVAC EMS, INC.
Doing business as
Air Evac Lifeteam
Practice address
827 Old Bremen Rd
Carrollton, GA 30117
Phone
(877) 288-5340
Fax
(417) 257-5761
NPI assigned
Dec 11, 2012
Last updated
Aug 3, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
AIR EVAC EMS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2018

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

Authorized official

Name
Eric Thomas
Title
SVP of Revenue Management
Phone
(877) 288-5340

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Air Ambulance 3416A0800X NU Primary

Addresses

Primary practice location

827 Old Bremen Rd
Carrollton, GA 30117

Mailing address

PO Box 106
West Plains, MO 65775-0106
Phone (417) 257-1585

Other names 1

  • Air Evac Lifeteam Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040430000654 GA Part B Supplier - Ambulance Service Supplier 8123931755 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thomaston, GA; Waycross, GA; Vidalia, GA; Tifton, GA; Statesboro, GA; Snellville, GA; Perry, GA; Milledgeville, GA…

Other NPIs on the same Medicare enrollment 16

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

View all 16

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
11D2065712Air Evac EMS, Inc Air Evac #112827 Old Bremen Rd, Carrollton, GA 30117Certificate of waiverSep 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Air Evac EMS162 organizations share this tax ID, including this one
Part of
Air Evac EMS

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

827 Old Bremen Rd
Carrollton, GA 30117
Phone (770) 832-3411

NPI Registry JSON

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533254400000",
    "number": "1891030201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 106",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657750106",
            "telephone_number": "417-257-1585",
            "fax_number": "417-257-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 OLD BREMEN RD",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "30117",
            "telephone_number": "877-288-5340",
            "fax_number": "417-257-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AIR EVAC EMS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AIR EVAC EMS INC",
        "enumeration_date": "2012-12-11",
        "last_updated": "2018-08-03",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "SVP OF REVENUE MANAGEMENT",
        "authorized_official_telephone_number": "877-288-5340"
    },
    "taxonomies": [
        {
            "code": "3416A0800X",
            "taxonomy_group": "",
            "desc": "Ambulance, Air Transport",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Air Evac Lifeteam",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Air Evac Lifeteam",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2018; 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.