NPIMap

Organization Active NPI

Hy-Vee Inc

  • Community/Retail Pharmacy
  • Davenport, IA
National Provider Identifier
1003842477
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
974 Issued in IA
Legal business name
HY-VEE INC
Practice address
1823 E Kimberly Rd
Davenport, IA 52807-2027
Phone
(515) 453-2784
Fax
(515) 327-2162
NPI assigned
Jun 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Angie Nelson
Title
Senior Vice President
Phone
(515) 267-2800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 974 IA
Community/Retail Pharmacy 3336C0003X 974 IA Primary

Addresses

Primary practice location

1823 E Kimberly Rd
Davenport, IA 52807-2027

Mailing address

PO Box 850442
Minneapolis, MN 55485-0442
Phone (515) 267-2800

Other identifiers 2

IdentifierTypeStateIssuer
0145037MedicaidIA
1618353OtherIANCPDP

Other names 1

  • Hy-Vee Pharmacy #3 (1107) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031230000598 IA Part B Supplier - Mass Immunization (Roster Biller Only) 7416855242 This NPI is an additional NPI on the enrollment
Practice locations: Albia, IA
O20040701000521 MN Part B Supplier - Mass Immunization (Roster Biller Only) 7416855242 44 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plymouth, MN; Preston, MN; Robbinsdale, MN; Rochester, MN; Saint Charles, MN; Saint Peter, MN; Savage, MN; Shakopee, MN…
O20100930075711 IA DME Supplier - PharmacyDME Supplier - Grocery Store 7416855242 Practice locations: Davenport, IA

Other NPIs on the same Medicare enrollment 42

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

View all 42

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
16D2205313Hy-Vee Pharmacy #3 - 11071823 East Kimberly Rd, Davenport, IA 52807Certificate of waiverDec 13, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Hy Vee Pharmacy #3 (1107)1823 E Kimberly Rd, Davenport, IA 52807-2027(563) 359-5313 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Nebulizer Equipment and/o… Does not accept assignmentParticipating since Dec 7, 2017

National Provider Directory

National Provider Directory
Tax ID family
Drug Town 7060278 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1823 E Kimberly Rd
Davenport, IA 52807
Phone (563) 359-5313

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1003842477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850442",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554850442",
            "telephone_number": "515-267-2800",
            "fax_number": "515-559-2593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 E KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072027",
            "telephone_number": "515-453-2784",
            "fax_number": "515-327-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HY-VEE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "515-267-2800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IA",
            "license": "974",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0145037",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1618353",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hy-Vee Pharmacy #3 (1107)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hy-Vee Pharmacy #3 (1107)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; 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.