NPIMap

Organization Active NPI

Foundation Care LLC

  • Pharmacy
  • Chesterfield, MO
National Provider Identifier
1205831963
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
2004013283 Issued in MO
Legal business name
FOUNDATION CARE LLC
Practice address
111 Chesterfield Industrial Blvd Ste 115
Chesterfield, MO 63005-1219
Phone
(877) 291-1122
Fax
(877) 291-1155
NPI assigned
Jun 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Authorized official

Name
Jessica Dawn Ciccolella-Kahl
Title
President, Director
Phone
(800) 511-5144

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X
Durable Medical Equipment & Medical Supplies 332B00000X 2004013283 MO
Pharmacy 333600000X 2004013283 MO Primary
Home Infusion Therapy Pharmacy 3336H0001X

Addresses

Primary practice location

111 Chesterfield Industrial Blvd Ste 115
Chesterfield, MO 63005-1219

Mailing address

PO Box 955362
Saint Louis, MO 63195-5362
Phone (855) 422-2742

Other identifiers 2

IdentifierTypeStateIssuer
2172192OtherPK
606143006MedicaidMO

Other names 1

  • Foundation Care LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20090922000276 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3274689955 Practice locations: Chesterfield, MO
O20091104000315 MO Part B Supplier - Pharmacy 3274689955 Practice locations: Chesterfield, MO
O20100930029414 MO DME Supplier - Pharmacy 3274689955 Practice locations: Chesterfield, MO

National Provider Directory

National Provider Directory
Tax ID family
Foundation Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

111 Chesterfield Industrial Blvd
Ste 115
Chesterfield, MO 63005
Phone (314) 410-2700

4010 Wedgeway Ct
Earth City, MO 63045
Phone (314) 291-1122

Practitioners & affiliated clinicians

Practitioners 11

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": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1205831963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955362",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955362",
            "telephone_number": "855-422-2742",
            "fax_number": "866-834-8523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 CHESTERFIELD INDUSTRIAL BLVD STE 115",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051219",
            "telephone_number": "877-291-1122",
            "fax_number": "877-291-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "CICCOLELLA-KAHL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PRESIDENT, DIRECTOR",
        "authorized_official_telephone_number": "800-511-5144"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "2004013283",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MO",
            "license": "2004013283",
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2172192",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606143006",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foundation Care LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Foundation Care LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.

Verify at the official NPI Registry.