NPIMap

Organization Active NPI

Javon Bea Hospital

Doing business as Mercyhealth Pharmacy - Riverside

  • Pharmacy
  • Rockford, IL
National Provider Identifier
1144790791
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
JAVON BEA HOSPITAL
Doing business as
Mercyhealth Pharmacy - Riverside
Practice address
8201 E Riverside Blvd Ste 1022
Rockford, IL 61114-2300
Phone
(815) 971-1100
Fax
(815) 971-9084
NPI assigned
Nov 27, 2018
Last updated
Jun 10, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Joseph D Malas
Title
Cfo
Phone
(815) 971-6738

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

8201 E Riverside Blvd Ste 1022
Rockford, IL 61114-2300

Mailing address

8201 E Riverside Blvd Ste 1022
Rockford, IL 61114-2300
Phone (815) 971-1100

Other identifiers 3

IdentifierTypeStateIssuer
7726440001OtherILIL MEDICARE
054020724OtherILIL STATE LICENSE
1494842OtherNCPDP

Other names 1

  • Mercyhealth Pharmacy - Riverside Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190306000182 IL DME Supplier - Pharmacy 1850299967 Practice locations: Rockford, IL
O20190910001539 IL Part B Supplier - Mass Immunization (Roster Biller Only) 1850299967 Practice locations: Rockford, IL

Other NPIs with the same Medicare PAC ID 2

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

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
Javon Bea Hospital8201 E Riverside Blvd, Rockford, IL 61114-2300(815) 971-1100 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Mar 6, 2019

National Provider Directory

National Provider Directory
Tax ID family
Rockford Memorial Hospital8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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.

Interoperability endpoints

  • FHIR API: https://epicproxy.mhsjvl.org/FHIRproxy/api/FHIR/R4/

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Van Matre Encompass Health Rehabilitation InstituteRockford, IL, CCN 143028 Hospital 5% Or Greater Indirect Ownership Interest (50%) Jul 31, 2015

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1543276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1144790791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8201 E RIVERSIDE BLVD STE 1022",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611142300",
            "telephone_number": "815-971-1100",
            "fax_number": "815-971-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 E RIVERSIDE BLVD STE 1022",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611142300",
            "telephone_number": "815-971-1100",
            "fax_number": "815-971-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAVON BEA HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HEALTH CORPORATION",
        "enumeration_date": "2018-11-27",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "MALAS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "815-971-6738"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL MEDICARE",
            "identifier": "7726440001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LICENSE",
            "identifier": "054020724",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1494842",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercyhealth Pharmacy - Riverside",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercyhealth Pharmacy - Riverside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.