NPIMap

Organization Active NPI

Geritom Med Inc

  • Long Term Care Pharmacy
  • Bloomington, MN
National Provider Identifier
1285621193
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
261375 Issued in MN
Legal business name
GERITOM MED INC
Doing business as
Geritom Med Inc
Practice address
10501 Florida Ave S
Bloomington, MN 55438-2553
Phone
(952) 854-1190
Fax
(952) 854-1082
NPI assigned
Oct 5, 2005
Last updated
Sep 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Dr. Jason Ryan WachtlNPI 1558507558
Title
Vice President
Phone
(952) 854-1190

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X 261375 MN Primary

Addresses

Primary practice location

10501 Florida Ave S
Bloomington, MN 55438-2553

Mailing address

10501 Florida Ave S
Bloomington, MN 55438-2553
Phone (952) 854-1190

Other identifiers 2

IdentifierTypeStateIssuer
718560000MedicaidMN
2046914OtherPK

Other names 1

  • GERITOM MED INC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930030558 MN DME Supplier - PharmacyDME Supplier - Medical Supply Company 8527022532 Practice locations: Bloomington, MN
O20201214002894 MN Part B Supplier - Mass Immunization (Roster Biller Only) 8527022532 Practice locations: Bloomington, MN

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
24D2184031Geritom Med, Inc10501 Florida Ave S, Bloomington, MN 55438Certificate of waiverMay 13, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Geritom Medical Inc10501 Florida Ave S, Bloomington, MN 55438-2553(952) 854-1190 Blood Glucose Monitors/Supplies (Non-Mail Order)|Ostomy Supplies|Tracheotomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment and/or Supplies|Surgical Dressings Does not accept assignmentParticipating since Jan 1, 2013

National Provider Directory

National Provider Directory

Locations

10501 Florida Ave S
Minneapolis, MN 55438
Phone (952) 854-1082

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1285621193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10501 FLORIDA AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554382553",
            "telephone_number": "952-854-1190",
            "fax_number": "952-854-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10501 FLORIDA AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554382553",
            "telephone_number": "952-854-1190",
            "fax_number": "952-854-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERITOM MED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "WACHTL",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "952-854-1190",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MN",
            "license": "261375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "718560000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2046914",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GERITOM MED INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GERITOM MED INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.