Active NPI
Mercy Family Pharmacy
- Community/Retail Pharmacy
- Dyersville, IA
National Provider Identifier
1154421469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 129
- Legal business name
- MERCY FAMILY PHARMACY
- Practice address
- 1111 3Rd St SW
Dyersville, IA 52040-1725 - Phone
- (563) 875-2947
- Fax
- (563) 875-8259
- NPI assigned
- Sep 25, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kay Takes
- Title
- President
- Phone
- (563) 589-8061
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 129 | IA | Primary |
Addresses
Primary practice location
1111 3Rd St SW
Dyersville, IA 52040-1725
Mailing address
1111 3Rd St SW
Dyersville, IA 52040
Phone (563) 875-2947
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2028884 | Other | PK | |
| 0180851 | Medicaid | IA |
Other names 1
- MERCY FAMILY PHARMACY DYERSVILLE
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190227000493 | IA | Part B Supplier - Pharmacy | 4688667025 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cascade, IA; Dyersville, IA; Dubuque, IA |
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1574640000000",
"number": "1154421469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 3RD ST SW",
"city": "DYERSVILLE",
"state": "IA",
"postal_code": "52040",
"telephone_number": "563-875-2947",
"fax_number": "563-875-8259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 3RD ST SW",
"city": "DYERSVILLE",
"state": "IA",
"postal_code": "520401725",
"telephone_number": "563-875-2947",
"fax_number": "563-875-8259"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MERCY FAMILY PHARMACY",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2019-11-25",
"status": "A",
"authorized_official_last_name": "TAKES",
"authorized_official_first_name": "KAY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "563-589-8061"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IA",
"license": "129",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2028884",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0180851",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MERCY FAMILY PHARMACY DYERSVILLE",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dyersville, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.