NPIMap

Organization Active NPI

Meijer Stores Limited Partnership

Doing business as Meijer Pharmacy #298

  • Community/Retail Pharmacy
  • Green Bay, WI
National Provider Identifier
1215472089
Registry record updated Jun 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEIJER STORES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #298
Practice address
2015 Shawano Ave
Green Bay, WI 54303-2606
Phone
(920) 496-8110
Fax
(920) 496-8165
NPI assigned
Jan 3, 2017
Last updated
Jun 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2017

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

Authorized official

Name
Jason Beauch, R.PHNPI 1518380062
Title
VP of Pharmacy Merchandising
Phone
(616) 791-3169

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 2

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

Addresses

Primary practice location

2015 Shawano Ave
Green Bay, WI 54303-2606

Mailing address

2929 Walker Ave NW
Attn: Managed Care Government Programs
Grand Rapids, MI 49544-6402
Phone (616) 791-3169

Other identifiers 2

IdentifierTypeStateIssuer
100065871MedicaidWI
1215472089MedicaidMI

Other names 1

  • Meijer Pharmacy #298 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150611002896 WI Part B Supplier - Mass Immunization (Roster Biller Only) 2062688971 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Bend, WI; Wauwatosa, WI; Greenfield, WI; Waukesha, WI; Sheboygan, WI; Pewaukee, WI; Manitowoc, WI; Oak Creek, WI…

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Member of 1

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

  • Meijer Inc

    dba Meijer Pharmacy #068

    • Community/Retail Pharmacy
    • Westland, MI
    • NPI 1578603908

    Member Of

    NPD member

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": "1483401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496361600000",
    "number": "1215472089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 WALKER AVE NW",
            "address_2": "ATTN: MANAGED CARE GOVERNMENT PROGRAMS",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495446402",
            "telephone_number": "616-791-3169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 SHAWANO AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032606",
            "telephone_number": "920-496-8110",
            "fax_number": "920-496-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER STORES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-03",
        "last_updated": "2017-06-02",
        "status": "A",
        "authorized_official_last_name": "BEAUCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "VP OF PHARMACY MERCHANDISING",
        "authorized_official_telephone_number": "616-791-3169",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100065871",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215472089",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #298",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2017; 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.