CMS-1500 Box 24J / 33a • NPI
1174514103
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
718 N SPRING ST, RANDOM LAKE, WI, 53075-1725
✓ 9-Digit EDI 837 ZIP+4 (53075-1725)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174514103 (RANDOM LAKE FIRE DEPARTMENT) 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
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1174514103)
Medicare Beneficiaries
45
Total Billed Services
1,375.3
Distinct CPT/HCPCS Codes
3
Medicare Allowed Total
$42,215.05
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
A0425 | Ground mileage, per statute mile | 1,310.3 |
A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 38 |
A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 27 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1174514103 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | RANDOM LAKE FIRE DEPARTMENT |
| 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 | 718 N SPRING ST, RANDOM LAKE, WI, 53075-1725 |
| Practice Telephone / Fax | Tel: (920) 994-9817 | Fax: (920) 994-2678 |
| Administrative Mailing Address | 718 N SPRING ST, RANDOM LAKE, WI, 53075-1725 |
| Enumeration & Last Sync | Enumerated: 2005-10-31 | CMS Record Updated: 2020-08-22 |
| Authorized Official | BLAINE WERNER (EMS Director) |
Clinic Location, Accessibility & Directions
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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"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (RANDOM LAKE FIRE DEPARTMENT)
Typical CPT / Diagnostic Procedures:- Advanced Life Support (ALS) Pre-Hospital Cardiac Monitoring & Defibrillation
- Pre-Hospital Trauma Immobilization, Airway Management & IV Access
- 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 TransportPlain English: Licensed Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance | State: WI | License: 60-01170 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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