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State University of Iowa

Organization Active NPI Pharmacy · Riverside, IA

NPI 1174845101 · NPPES record last updated Sep 6, 2018

Key facts

NPI
1174845101
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
18469 (IA)
Legal business name
STATE UNIVERSITY OF IOWA
Practice address
3056 River Crossing Court
Ste a
Riverside, IA 52327
Phone
(319) 467-8383
Fax
(319) 467-8378
NPI assigned
Feb 18, 2010
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 4

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 20

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

Corporate family (same tax ID) 21

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

Member of 1

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

Practitioners 1,886

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

View all 1,886

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2004157Ui Healthcare Center- River Crossing
3056 River Crossing Court, Riverside, IA 52327		Certificate of waiverAug 15, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IA

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Louis V Kirchoff MD (57 organizations share this tax ID)

Locations

200 Hawkins Dr
#1353
Iowa City, IA 52242
Phone (319) 384-5415

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 18469 IA Yes
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 identifiers

IdentifierTypeStateIssuer
0402616MedicaidIA
1623772OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names

  • UI Healthcare-River Crossing Pharmacy Doing business as

Other providers in Riverside, IA

All providers in Riverside, IA · Pharmacy in Iowa

Sources for this page

Verify at the official NPI Registry.