NPIMap

Organization Active NPI

Garfield Beach CVS, L.L.C.

  • Pharmacy
  • Atwater, CA
National Provider Identifier
1154507374
Registry record updated Aug 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
GARFIELD BEACH CVS, L.L.C.
Practice address
1651 Bellevue Rd
Atwater, CA 95301
Phone
(209) 358-3304
NPI assigned
Jan 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2011

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

Authorized official

Name
Mrs. Susan Colbert
Title
Director Payer Relations
Phone
(401) 770-2751

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X CA
Pharmacy 333600000X CA Primary
Community/Retail Pharmacy 3336C0003X CA

Addresses

Primary practice location

1651 Bellevue Rd
Atwater, CA 95301

Mailing address

One CVS Drive
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895
Phone (401) 765-1500

Other identifiers 2

IdentifierTypeStateIssuer
1154507374MedicaidCA
5629259OtherCAOTHER COMMERCIAL NUMBER - NCPDP

Other names 1

  • CVS PHARMACY # 03117 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080117000218 CA Part B Supplier - Mass Immunization (Roster Biller Only) 5799866620 This NPI is an additional NPI on the enrollment
O20100930087855 CA DME Supplier - Pharmacy 5799866620 Practice locations: Atwater, CA

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
05D2271390CVS/Pharmacy #031171651 Bellevue Ave, Atwater, CA 95301Certificate of waiverOct 31, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy #031171651 Bellevue Rd, Atwater, CA 95301-2608(209) 358-3304 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… Does not accept assignmentParticipating since Jan 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
CVS Pharmacy 09583721 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1154507374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE CVS DRIVE",
            "address_2": "BOX 1075 - PHARMACY ENROLLMENTS",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "02895",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 BELLEVUE RD",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "95301",
            "telephone_number": "209-358-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARFIELD BEACH CVS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154507374",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER COMMERCIAL NUMBER - NCPDP",
            "identifier": "5629259",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY # 03117",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atwater, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.