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GOUVERNEUR VOLUNTEER RESCUE SQUAD INC
NPI 1245228782
Ambulance in Gouverneur, NY

Active since October 10, 2005CLIA 33D2335296 · Waiver
1024 US HIGHWAY 11, GOUVERNEUR, NY 13642(315) 287-1321(315) 287-3954 Get Directions Write a Review

NPPES record last updated: January 6, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Gouverneur Volunteer Rescue Squad Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GOUVERNEUR VOLUNTEER RESCUE SQUAD INC (NPI 1245228782) is a healthcare organization registered as an ambulance in Gouverneur, New York and active in the NPI registry since October 2005. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Mark Deavers, Director Of Operations, as its authorized official.

NPPES Registry Identity

NPI1245228782
Entity TypeOrganization
Primary Taxonomy341600000X
Legal Business NameGOUVERNEUR VOLUNTEER RESCUE SQUAD INC
Location Address1024 US HIGHWAY 11Gouverneur, NY 13642-3507
Mailing Address892 New Castle RdSlippery Rock, PA 16057-4228 · (800) 280-5974 · Fax (724) 794-1633
Phone(315) 287-1321
Fax(315) 287-3954
Organization SubpartNo
Authorized OfficialMark DeaversDirector Of Operations · (315) 287-1321
Enumeration DateOctober 10, 2005
Last NPPES UpdateJanuary 6, 2015
✔ NPI 1245228782 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAmbulanceTransportation Services
Taxonomy Code341600000X
License✔ Licensed in NY · 4417
Definition
An emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States include ground (surface) ambulance, rotor-wing (helicopter), and fixed-wing aircraft (airplane).
Also ListedNon-emergency Medical Transport (VAN)Taxonomy 343900000X · License 43946 (NY)
1024 US HIGHWAY 11, Gouverneur, NY 13642
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Other Identifiers 4

Other590008863Railroad Medicare
Medicaid01640344NY
Other02988094NY · Non-medical Medicaid Provider Number
Medicare PIN53989BNY

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Gouverneur Volunteer Rescue Squad Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew YorkEnrollment IDO20080529000731Non-DME Part B · Ambulance Service SupplierDue dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2335296

Gouverneur Volunteer Rescue Squad Inc · Gouverneur, NY
Active · expires Mar 26, 2027
CLIA Number33D2335296
Laboratory TypeAmbulance
Certificate Effective DateDecember 9, 2025
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Ryan W. Coates
Laboratory Phone(315) 287-1321
Laboratory LocationGouverneur Volunteer Rescue Squad Inc1024 Us Hwy 11, Gouverneur, NY 13642
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Ground mileage, per statute mile A0425
Ground mileage per statute mile is a method of calculating the cost of transportation for medical services. It is used when a patient needs to be transported by ground ambulance. The cost is calculated per mile, from the pick-up location to the medical facility.
5,463 services167 patients
Ambulance service, basic life support, emergency transport (bls-emergency) A0429
Ambulance service with basic life support (BLS-Emergency) provides immediate transport for patients in critical situations. Medical professionals on board deliver essential care like CPR, wound dressing, and oxygen therapy to stabilize patients during the journey.
112 services85 patients
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) A0427
Ambulance Service, Advanced Life Support, Level 1 (ALS 1 - Emergency) is a critical care transport service for emergency situations. It includes a team of healthcare professionals equipped with advanced skills and tools to manage life-threatening conditions during transport.
79 services65 patients
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) A0426
Ambulance Service, Advanced Life Support, Non-Emergency Transport, Level 1 (ALS 1) is a medical transportation service for patients who don't have an immediate life-threatening condition but require advanced medical monitoring or interventions during the journey.
42 services38 patients
Ambulance service, basic life support, non-emergency transport, (bls) A0428
Basic Life Support (BLS) non-emergency ambulance service provides safe transportation for patients who don't need immediate medical attention. It includes monitoring vital signs, ensuring comfort, and administering basic care during transport.
25 services24 patients

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GOUVERNEUR VOLUNTEER RESCUE SQUAD INC
Ambulance
1024 US HIGHWAY 11
GOUVERNEUR, NY 13642
St. Lawrence County (315) 287-1321

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gouverneur Volunteer Rescue Squad Inc's NPI number?

The NPI number for Gouverneur Volunteer Rescue Squad Inc is 1245228782. It was assigned to this organization in the NPPES registry on October 10, 2005.

Where is Gouverneur Volunteer Rescue Squad Inc located?

Gouverneur Volunteer Rescue Squad Inc is located at 1024 Us Highway 11, Gouverneur, NY 13642. The listed phone number is (315) 287-1321.

What is Gouverneur Volunteer Rescue Squad Inc's specialty?

The primary specialty registered for this NPI is Ambulance with taxonomy code 341600000X.

Is Gouverneur Volunteer Rescue Squad Inc enrolled in Medicare?

Yes. Gouverneur Volunteer Rescue Squad Inc is registered in the Medicare PECOS enrollment system.

When is Gouverneur Volunteer Rescue Squad Inc's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Ambulance Service Supplier) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Gouverneur Volunteer Rescue Squad Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2335296) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Gouverneur Volunteer Rescue Squad Inc was last updated on January 6, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.