NPIMap

Organization Active NPI

Ingles Markets Inc

Doing business as Ingles Pharmacy #397

  • Community/Retail Pharmacy
  • Elizabethton, TN
National Provider Identifier
1063851657
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
00005184 Issued in TN
Legal business name
INGLES MARKETS INC
Doing business as
Ingles Pharmacy #397
Practice address
768 W Elk Ave
Elizabethton, TN 37643-2517
Phone
(423) 542-2002
Fax
(423) 542-2023
NPI assigned
Jun 18, 2013
Last updated
Aug 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Authorized official

Name
Mr. Stephen V Cucchi, RPH
Title
VP of Pharmacy
Phone
(828) 669-2941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 00005184 TN Primary

Addresses

Primary practice location

768 W Elk Ave
Elizabethton, TN 37643-2517

Mailing address

PO Box 603941
Charlotte, NC 28260-3941
Phone (828) 669-2941

Other identifiers 2

IdentifierTypeStateIssuer
4446084OtherNCPDP
4446084MedicaidTN

Other names 1

  • Ingles Pharmacy #397 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090914000457 TN Part B Supplier - Mass Immunization (Roster Biller Only) 5092867614 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jonesborough, TN; Powell, TN; Morristown, TN; Lenoir City, TN; Knoxville, TN; Kingsport, TN; Johnson City, TN; Greeneville, TN…
O20131204000446 TN DME Supplier - Pharmacy 5092867614 Practice locations: Elizabethton, TN

Other NPIs on the same Medicare enrollment 10

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

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
44D2184849Ingles Markets, Inc (Ingles Pharmacy #397)768 W Elk Ave, Elizabethton, TN 37643Certificate of waiverMay 25, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Ingles Markets Inc768 W Elk Ave, Elizabethton, TN 37643-2517(423) 542-2002 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Sep 24, 2024

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1063851657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603941",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603941",
            "telephone_number": "828-669-2941",
            "fax_number": "828-669-3685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 W ELK AVE",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432517",
            "telephone_number": "423-542-2002",
            "fax_number": "423-542-2023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGLES MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-18",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "CUCCHI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "VP OF PHARMACY",
        "authorized_official_telephone_number": "828-669-2941",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "00005184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4446084",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4446084",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ingles Pharmacy #397",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ingles Pharmacy #397",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabethton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.