NPIMap

Organization Active NPI

Premium Health Inc

Doing business as Premium Rx

  • Community/Retail Pharmacy
  • Brooklyn, NY
National Provider Identifier
1083227235
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PREMIUM HEALTH INC
Doing business as
Premium Rx
Practice address
4510 16TH Ave FL 3
Brooklyn, NY 11204-1101
Phone
(844) 370-6199
Fax
(929) 387-3728
NPI assigned
Aug 27, 2020
Last updated
Dec 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Joel Wright
Title
President Pharmacy Services
Phone
(806) 242-7782

Specialties & licenses 1

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

Addresses

Primary practice location

4510 16TH Ave FL 3
Brooklyn, NY 11204-1101

Mailing address

320 S Polk St Ste 200
Amarillo, TX 79101-1436
Phone (806) 242-7782

Other identifiers 1

IdentifierTypeStateIssuer
06979006MedicaidNY

Other names 1

  • Premium Rx Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210610003335 NY DME Supplier - Pharmacy 4981830023 Practice locations: Brooklyn, NY
O20220214000863 NY Part B Supplier - Pharmacy 4981830023 1 other NPI on this enrollment
Practice locations: Brooklyn, NY; Far Rockaway, NY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Premium Health, Inc.4510 16TH Ave, Brooklyn, NY 11204-1101(844) 370-6199 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Apr 6, 2014

National Provider Directory

National Provider Directory
Tax ID family
Premium Health Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

320 S Polk St
Ste 800
Amarillo, TX 79101

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Premium Health Inc.Brooklyn, NY, CCN 571881 Federally qualified health center Operational/Managerial Control (100%) Apr 20, 2010
Premium Health, Inc.Far Rockaway, NY, CCN 571888 Federally qualified health center Operational/Managerial Control (100%) Apr 20, 2010
Premium Health, Inc.Brooklyn, NY, CCN 571885 Federally qualified health center Operational/Managerial Control (100%) Apr 20, 2010
Premium Health, Inc.Far Rockaway, NY, CCN 571938 Federally qualified health center Operational/Managerial Control (100%) Jun 6, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1598486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1083227235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S POLK ST STE 200",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791011436",
            "telephone_number": "806-242-7782",
            "fax_number": "929-387-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 16TH AVE FL 3",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112041101",
            "telephone_number": "844-370-6199",
            "fax_number": "929-387-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-27",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT PHARMACY SERVICES",
        "authorized_official_telephone_number": "806-242-7782"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06979006",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premium Rx",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premium Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.