NPIMap

Roundys Supermarkets Inc

Organization Active NPI Community/Retail Pharmacy · Oak Lawn, IL

NPI 1194133280 · NPPES record last updated Jul 11, 2016

Key facts

NPI
1194133280
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
054.018723 (IL)
Legal business name
ROUNDYS SUPERMARKETS INC
Practice address
11000 S Cicero Ave
Oak Lawn, IL 60453-5504
Phone
(708) 346-0726
Fax
(708) 346-0755
NPI assigned
Aug 1, 2014
Organization subpart
No

Authorized official

Name
William Dowling
Title
Vice President
Phone
(414) 231-5000

Other NPIs on the same Medicare enrollment 41

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

View all 41

Corporate family (same tax ID) 20

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

Member of 3

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

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
14D2115367Mariano'S Pharmacy #8517
11000 S Cicero Ave, Oak Lawn, IL 60453		Certificate of waiverJul 5, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Roundys Supermarkets Inc
11000 S Cicero Ave, Oak Lawn, IL 60453-5504 · (708) 346-0726		 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignment
Participating since Dec 18, 2023

Medicare participation

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

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110329000044 IL Part B Supplier - Mass Immunization (Roster Biller Only) 5698858470 41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Skokie, IL; Harwood Heights, IL; Hoffman Estates, IL; Lake Zurich, IL; Lombard, IL; Gurnee, IL; Naperville, IL; Northbrook, IL…
O20141124001730 IL DME Supplier - Pharmacy 5698858470 Practice locations: Oak Lawn, IL

National Provider Directory

Tax ID family
Mariano'S Pharmacy (103 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054.018723 IL Yes

Addresses

Primary practice location

11000 S Cicero Ave
Oak Lawn, IL 60453-5504

Mailing address

PO Box 473
Ms-2870
Milwaukee, WI 53201-0473
Phone (414) 231-6153

Other identifiers

IdentifierTypeStateIssuer
2147192OtherPK

Other names

  • MARIANO'S Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 11, 2016.

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1194133280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 473",
            "address_2": "MS-2870",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532010473",
            "telephone_number": "414-231-6153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11000 S CICERO AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604535504",
            "telephone_number": "708-346-0726",
            "fax_number": "708-346-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-01",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "DOWLING",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "414-231-5000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.018723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2147192",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIANO'S",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Lawn, IL

All providers in Oak Lawn, IL · Community/Retail Pharmacy in Illinois

Sources for this page

Verify at the official NPI Registry.