FORMAN AMBULANCE SERVICE – Air Ambulance, NPI 1700871910
Air Ambulance
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for FORMAN AMBULANCE SERVICE
PO BOX 648
MANITO, IL 615460648
Phone: (309) 968-6902
Fax: (309) 968-6649
Type: Mailing
205, North Broadway Street, Manito, Mason County, Illinois, 61546, United States
MANITO, IL 615460648
Phone: (309) 968-6902
Fax: (309) 968-6649
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2008-03-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20080324000014 | O | Ambulance Service Supplier | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 1,912 | 67 | $0 |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 92 | 67 | $0 |
Insurance plans in this area (ZIP 61546)
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