NPIMap

Organization Active NPI

Meijer Great Lakes Limited Partnership

Doing business as Meijer Pharmacy #262

  • Community/Retail Pharmacy
  • Orland Park, IL
National Provider Identifier
1033489836
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054017480 Issued in IL
Legal business name
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #262
Practice address
15701 S 71St CT
Orland Park, IL 60462-6800
Phone
(708) 342-9910
Fax
(708) 342-9965
NPI assigned
Jan 10, 2012
Last updated
Sep 7, 2021By the provider in NPPES
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, RPHNPI 1306275649
Title
Managed Care Government Contracting
Phone
(616) 249-6272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 054017480 IL
Community/Retail Pharmacy 3336C0003X 054017480 IL Primary

Addresses

Primary practice location

15701 S 71St CT
Orland Park, IL 60462-6800

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169

Other names 1

  • Meijer Pharmacy #262 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…
O20121023000213 IL DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 4385829480 Practice locations: Orland Park, 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
14D2008891Meijer Pharmacy #26215701 71St Court, Orland Park, IL 60462Certificate of waiverJun 20, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Pharmacy #26215701 71St Court, Orland Park, IL 60462-2800(708) 342-9910 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers Does not accept assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Meijer Great Lakes Limited Partnership37 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.

  • Meijer Inc.

    dba Meijer Pharmacy #333

    • Community/Retail Pharmacy
    • Hillsdale, MI
    • NPI 1205698321

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630972800000",
    "number": "1033489836",
    "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",
            "telephone_number": "616-791-3169",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15701 S 71ST CT",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604626800",
            "telephone_number": "708-342-9910",
            "fax_number": "708-342-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER GREAT LAKES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "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": "MANAGED CARE GOVERNMENT CONTRACTING",
        "authorized_official_telephone_number": "616-249-6272",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "054017480",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054017480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #262",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meijer Pharmacy #262",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orland Park, 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.