BROOKFIELD TOWNSHIP — NPI 1104808492 (Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance in BROOKFIELD, OH)

CMS-1500 Box 24J / 33a • NPI

1104808492

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3416L0300X (CMS 59)

Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance

Box 32 Service Location & ZIP+4

774 STATE ROUTE 7 NE, BROOKFIELD, OH, 44403-9630

✓ 9-Digit EDI 837 ZIP+4 (44403-9630)

Practice Phone & Referral Fax

(330) 448-1000

Fax: (330) 448-4262

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104808492 (BROOKFIELD TOWNSHIP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104808492` (NPI-2 Organization / Facility)
Provider / Legal Name	BROOKFIELD TOWNSHIP
Plain-English Specialty	Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance NUCC Code: `3416L0300X` (Ambulance, Land Transport)
Certifying / Licensing Body	State EMS Authority / National Registry of Emergency Medical Technicians (NREMT)
Practice Location Address	774 STATE ROUTE 7 NE, BROOKFIELD, OH, 44403-9630
Practice Telephone / Fax	Tel: (330) 448-1000 \| Fax: (330) 448-4262
Administrative Mailing Address	PO BOX 392907, PITTSBURGH, PA, 15251-9907
Enumeration & Last Sync	Enumerated: 2005-11-14 \| CMS Record Updated: 2024-05-24
Authorized Official	DAVID MASIROVITS (Chief)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

774 STATE ROUTE 7 NE, BROOKFIELD, OH, 44403-9630

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Plain-English Taxonomy & CMS Crosswalk (3416L0300X)

What Does Taxonomy Code 3416L0300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3416L0300X translates to:
"Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 59 (Ambulance Service Provider)
Certifying / Accrediting Authority: State EMS Authority / National Registry of Emergency Medical Technicians (NREMT)
Clinical Scope: Emergency 911 pre-hospital medical response or medically supervised inter-hospital critical care transport.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BROOKFIELD TOWNSHIP)

Typical CPT / Diagnostic Procedures:

Advanced Life Support (ALS) Pre-Hospital Cardiac Monitoring & Defibrillation
Pre-Hospital Trauma Immobilization, Airway Management & IV Access

Common Therapeutic Classes:

Pre-Hospital Epinephrine, Aspirin, Nitroglycerin, Naloxone & Albuterol

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3416L0300X` — Ambulance, Land Transport Plain English: Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BROOKFIELD TOWNSHIP (NPI #1104808492)