NPIMap

Organization Active NPI

Meijer Great Lakes Limited Partnership

  • Community/Retail Pharmacy
  • Bradley, IL
National Provider Identifier
1003315680
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Practice address
990 N Kinzie Ave
Bradley, IL 60915
Phone
(779) 301-8210
Fax
(779) 301-8265
NPI assigned
Feb 8, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ian Nagy
Title
Manager, Third Party Govt. Programs
Phone
(616) 249-6272

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

990 N Kinzie Ave
Bradley, IL 60915

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402

Other names 1

  • Meijer Pharmacy # 301 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121008000019 IL Part B Supplier - Mass Immunization (Roster Biller Only) 4385829480 25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McHenry, IL; Plainfield, IL; Mokena, IL; Normal, IL; Orland Park, IL; Oswego, IL; Rockford, IL; Rolling Meadows, IL…
O20180620000623 IL DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 4385829480 Practice locations: Bradley, IL

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 25

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2146666Meijer Pharmacy #301990 N Kinzie Ave, Bradley, IL 60915Certificate of waiverApr 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Meijer37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630972800000",
    "number": "1003315680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 WALKER AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495446402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 N KINZIE AVE",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "60915",
            "telephone_number": "779-301-8210",
            "fax_number": "779-301-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER GREAT LAKES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-08",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A",
        "authorized_official_last_name": "NAGY",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "MANAGER, THIRD PARTY GOVT. PROGRAMS",
        "authorized_official_telephone_number": "616-249-6272"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy # 301",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bradley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.