NAICS 621910 Quarterly Industry Report
Ambulance Services
Comprehensive industry research for valuation professionals, business owners, buyers, and lenders
NAICS Code: 621910Sector: Health Care and Social Assistance (62)Updated: Q1 2026
About This Report
This industry profile for Ambulance Services (NAICS 621910) draws on data from the U.S. Census Bureau[9], Bureau of Labor Statistics[6], CMS[8], and SBA size standards database[7]. Published by Fair Market Value and updated quarterly, it provides valuation professionals, EMS industry analysts, and healthcare transport investors with current market data. All quantitative claims are sourced to publicly verifiable databases.
Industry Snapshot
Key metrics for the ambulance services industry.
NAICS Sector
62
Health Care and Social Assistance
Industry Definition & Overview
Ambulance Services (NAICS 621910) encompasses establishments primarily engaged in providing transportation of patients by ground or air, along with medical care, to and from hospitals and other health care facilities per the U.S. Census Bureau[5]. Services include emergency 911 response, non-emergency medical transport, interfacility transfer, and air ambulance helicopter and fixed-wing operations. Both public fire department-based and private commercial ambulance providers operate within this classification.
Ground ambulance revenue reached $31 billion in 2023 per industry data. Roughly 101,900 paramedics and 270,000 EMTs held jobs in 2024 per the Bureau of Labor Statistics[6], with the EMS workforce growing from 216,000 to 290,000 between 2011 and 2019. American Medical Response (AMR), a subsidiary of Global Medical Response, operates as the largest private ambulance provider with operations in 40 states. Rural Metro, Acadian Ambulance, and PHI Air Medical maintain additional multi-state operations. Fire department-based EMS represents the majority of 911 emergency response in metropolitan areas.
Per the SBA Table of Size Standards[7], the size standard is $23 million in average annual receipts. Federal ambulance vehicle standards under KKK-A-1822 (2019 revision) establish design, performance, and safety specifications. Minimum staffing requires two crew members with at least one EMT-Basic, while Advanced Life Support (ALS) units require an EMT-Paramedic. Medicare reimburses ambulance services based on geographic base rates with mileage adjustments, covering 80 percent of the approved amount after the Part B deductible per CMS[8] payment guidelines. Surprise billing protections under the No Surprises Act affect air ambulance billing practices for commercially insured patients.
What's Included in This Industry
- Emergency 911 ground ambulance response and transport
- Advanced Life Support (ALS) paramedic emergency services
- Basic Life Support (BLS) EMT transport services
- Non-emergency medical transport and scheduled transfers
- Interfacility critical care transport operations
- Air ambulance helicopter and fixed-wing transport
- Community paramedicine and mobile integrated health programs
- Event standby and mass gathering medical coverage
- Ambulance vehicle fleet maintenance and equipment management
- Medicare ambulance billing and documentation compliance
NAICS Classification Hierarchy
| Level | Description | Code |
|---|---|---|
| Sector | Health Care and Social Assistance | 62 |
| Subsector | Ambulatory Health Care Services | 621 |
| Industry Group | Other Ambulatory Health Care Services | 6219 |
| NAICS Industry | Ambulance Services | 62191 |
| National Industry | Ambulance Services | 621910 |
Related NAICS Codes
| Code | Description | Relationship |
|---|---|---|
| 622110 | General Medical and Surgical Hospitals | General Medical and Surgical Hospitals serve as primary destinations for emergency ambulance transports, with hospital emergency departments receiving the majority of 911 ambulance patients and generating interfacility transfer requests for specialty care |
| 621493 | Freestanding Ambulatory Surgical and Emergency Centers | Freestanding Ambulatory Surgical Centers occasionally require ambulance transport for patients experiencing surgical complications or adverse events that exceed outpatient management capabilities during or after procedures |
| 621111 | Offices of Physicians (except Mental Health Specialists) | Offices of Physicians (General) order non-emergency medical transport for patients requiring ambulance-level care to reach medical appointments, diagnostic testing, and specialty consultations when other transportation is medically inappropriate |
| 524114 | Direct Health and Medical Insurance Carriers | Direct Health and Medical Insurance Carriers administer ambulance benefit coverage and set reimbursement rates, with the No Surprises Act affecting air ambulance billing for commercially insured patients transported by out-of-network providers |
| 621610 | Home Health Care Services | Home Health Care Services coordinate with ambulance providers for emergency transport of homebound patients experiencing acute medical events, with home health nurses frequently initiating 911 calls during patient visits |
| 621498 | All Other Outpatient Care Centers | All Other Outpatient Care Centers including urgent care facilities serve as alternative destinations for lower-acuity ambulance patients, with community paramedicine programs directing appropriate patients to urgent care rather than hospital emergency departments |
Geographic Concentration
Top states by share of national establishments.
| # | State | % Est. | Total Est. |
|---|---|---|---|
| 1 | Texas | 10.1% | 567 |
| 2 | Pennsylvania | 9.2% | 517 |
| 3 | California | 7.4% | 418 |
| 4 | New York | 6.2% | 348 |
| 5 | Illinois | 3.6% | 203 |
| 6 | Georgia | 3.4% | 191 |
| 7 | Ohio | 3.2% | 181 |
| 8 | Florida | 3.1% | 173 |
| 9 | New Jersey | 3.0% | 168 |
| 10 | Arizona | 2.9% | 166 |
% Of Establishments
0%
10%
Source: County Business Patterns, U.S. Census Bureau[3]
SBA Lending Summary
368
Total SBA Loans
$197.6M
Total Loan Volume
$537K
Average Loan Size
9 yrs
Average Loan Term
10.68%
Average Interest Rate
9,960
Jobs Supported
Source: SBA 7(a) Program Data, U.S. Small Business Administration — FY 2025[4]
Key Insight: Per the SBA Table of Size Standards[7], Ambulance Services (NAICS 621910) has a size standard of $23 million in average annual receipts for federal contracting purposes. SBA lending programs[10] support fleet acquisition, medical equipment investment, and service territory expansion for qualifying ambulance service operators. Eligible businesses can access SBA 7(a) loans[11] for working capital, equipment, and acquisition financing, while 504 loans[12] support major fixed-asset purchases including real estate and heavy machinery.
Top SBA Lenders
| # | Lender | Loans | Volume | Avg Loan |
|---|---|---|---|---|
| 1 | Cadence Bank | 8 | $40.0M | $5.0M |
| 2 | First Security Bank and Trust Company | 24 | $34.4M | $1.4M |
| 3 | Idaho Central CU | 24 | $33.1M | $1.4M |
| 4 | FinWise Bank | 8 | $31.6M | $4.0M |
| 5 | The Huntington National Bank | 48 | $10.0M | $207K |
Frequently Asked Questions
Common questions about this industry.
What is the NAICS code for ambulance services?
NAICS 621910 covers ambulance services providing ground and air medical transportation including emergency 911 response, non-emergency transport, and interfacility transfers per the U.S. Census Bureau[5].
How large is the ambulance services industry?
Ground ambulance revenue reached $31 billion in 2023 per industry data, with roughly 101,900 paramedics and 270,000 EMTs employed in 2024 per the Bureau of Labor Statistics[6].
What is the SBA size standard for ambulance services?
The SBA size standard[7] is $23 million in average annual receipts, determining eligibility for federal small business contracting programs and SBA lending products.
What is the difference between ALS and BLS ambulance?
Advanced Life Support (ALS) units require an EMT-Paramedic who can perform advanced procedures including intubation, IV medication administration, and cardiac monitoring, while Basic Life Support (BLS) units staff EMT-Basics providing oxygen, splinting, and basic patient assessment per Bureau of Labor Statistics[6] occupational data.
How does Medicare reimburse ambulance services?
Medicare covers 80 percent of the approved ambulance amount after the Part B deductible per CMS[8] payment guidelines, with reimbursement based on geographic base rates and mileage adjustments for ground transport.
Who is the largest private ambulance provider?
American Medical Response (AMR), a Global Medical Response subsidiary, operates as the largest private ambulance provider with operations in 40 states per industry tracking data, with Rural Metro, Acadian Ambulance, and PHI Air Medical maintaining additional networks.
What vehicle standards apply to ambulances?
Federal ambulance vehicle standards under KKK-A-1822 (2019 revision) establish design, performance, and safety specifications per NHTSA[13] regulatory guidance, with minimum staffing requiring two crew members including at least one certified EMT.
How does the No Surprises Act affect ambulance billing?
Surprise billing protections under the No Surprises Act affect air ambulance billing for commercially insured patients per CMS[8] consumer protection guidelines, prohibiting balance billing by out-of-network air ambulance providers and establishing independent dispute resolution processes.
Sources & References
Government datasets and editorial sources used in this report.
- [1]U.S. Bureau of Labor Statistics, Quarterly Census of Employment and Wages bls.gov
- [2]U.S. Census Bureau, Economic Census census.gov
- [3]U.S. Census Bureau, County Business Patterns census.gov
- [4]U.S. Small Business Administration, SBA 7(a) Loan Program Data data.sba.gov
- [5]U.S. Census Bureau census.gov
- [6]Bureau of Labor Statistics bls.gov
- [7]SBA Table of Size Standards sba.gov
- [8]CMS cms.gov
- [9]U.S. Census Bureau data.census.gov
- [10]SBA lending programs sba.gov
- [11]SBA 7(a) loans sba.gov
- [12]504 loans sba.gov
- [13]NHTSA nhtsa.gov
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