NPIMap

Organization Active NPI

State University of Iowa

Doing business as UI Healthcare-River Crossing Pharmacy

  • Pharmacy
  • Riverside, IA
National Provider Identifier
1174845101
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
18469 Issued in IA
Legal business name
STATE UNIVERSITY OF IOWA
Doing business as
UI Healthcare-River Crossing Pharmacy
Practice address
3056 River Crossing Court
Ste a
Riverside, IA 52327
Phone
(319) 467-8383
Fax
(319) 467-8378
NPI assigned
Feb 18, 2010
Last updated
Sep 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

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

Authorized official

Name
Jay Brooks Jackson, MDNPI 1972542652
Title
Vice President for Medical Affairs
Phone
(319) 335-8064

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 18469 IA Primary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 1370 IA

Addresses

Primary practice location

3056 River Crossing Court
Ste a
Riverside, IA 52327

Mailing address

3056 River Crossing Court
Ste a
Riverside, IA 52327-4724
Phone (319) 467-8383

Other names 1

  • UI Healthcare-River Crossing Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180601000705 IA DME Supplier - Pharmacy 7618884230 Practice locations: Riverside, IA
O20230420000460 IA Part B Supplier - Mass Immunization (Roster Biller Only) 7618884230 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coralville, IA; Des Moines, IA; Iowa City, IA; North Liberty, IA; Riverside, IA

Other NPIs with the same Medicare PAC ID 20

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

View all 20

Other NPIs on the same Medicare enrollment 6

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
16D2004157Ui Healthcare Center- River Crossing3056 River Crossing Court, Riverside, IA 52327Certificate of waiverAug 15, 2026

National Provider Directory

National Provider Directory
Tax ID family
Brian W Omeara MD61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

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

View all 21

Member of 1

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

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
University of Iowa Health Care Medical CenterIowa City, IA, CCN 160058 Hospital Other Jul 1, 1966
University of Iowa Health Care Medical CenterIowa City, IA, CCN 16S058 Hospital Other Jul 1, 1966
University of Iowa Health Care Medical Center DowntownIowa City, IA, CCN 160029 Hospital Other Jan 31, 2024
University of Iowa Health Care Medical Center Downtown Home HealthCoralville, IA, CCN 167181 Home health agency Other Jan 31, 2024

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536192000000",
    "number": "1174845101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3056 RIVER CROSSING COURT",
            "address_2": "STE A",
            "city": "RIVERSIDE",
            "state": "IA",
            "postal_code": "523274724",
            "telephone_number": "319-467-8383",
            "fax_number": "319-467-8378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3056 RIVER CROSSING COURT",
            "address_2": "STE A",
            "city": "RIVERSIDE",
            "state": "IA",
            "postal_code": "52327",
            "telephone_number": "319-467-8383",
            "fax_number": "319-467-8378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE UNIVERSITY OF IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2018-09-06",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "BROOKS",
        "authorized_official_title_or_position": "VICE PRESIDENT FOR MEDICAL AFFAIRS",
        "authorized_official_telephone_number": "319-335-8064",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IA",
            "license": "18469",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "1370",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UI Healthcare-River Crossing Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverside, IA

Sources for this page

Verify at the official NPI Registry.