NPIMap

Organization Active NPI

Moore Family Stores Inc.

Doing business as Martinsville Pharmacy

  • Community/Retail Pharmacy
  • Martinsville, IL
National Provider Identifier
1295810422
Registry record updated Jun 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054020327 Issued in IL
Legal business name
MOORE FAMILY STORES INC.
Doing business as
Martinsville Pharmacy
Practice address
890 E Ridgelawn Rd
Martinsville, IL 62442-2551
Phone
(217) 382-4004
Fax
(217) 382-3476
NPI assigned
Oct 26, 2006
Last updated
Jun 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2022

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

Authorized official

Name
Trent Moore
Title
Owner/President
Phone
(217) 362-6226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054020327 IL Primary

Addresses

Primary practice location

890 E Ridgelawn Rd
Martinsville, IL 62442-2551

Mailing address

2245 W Mound Rd
Decatur, IL 62526-9367
Phone (217) 362-6226

Other names 1

  • Martinsville Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100811000759 IL Part B Supplier - Mass Immunization (Roster Biller Only) 8921132051 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nokomis, IL; Robinson, IL; Tuscola, IL; Virden, IL
O20171208001049 IL Part B Supplier - Mass Immunization (Roster Biller Only) 0345507802 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Casey, IL; Effingham, IL; Martinsville, IL; Neoga, IL; Toledo, IL
O20180509000974 IL DME Supplier - Pharmacy 0345507802 Practice locations: Martinsville, IL

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Moore Family Stores Inc890 E Ridgelawn Rd, Martinsville, IL 62442-2551(217) 832-4004 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Seat Lift Mechanisms|Walkers|Wheelchair Seating/Cushions|Ostomy Supplies|Urological Supplies|Surgical Dressings Does not accept assignmentParticipating since Aug 1, 2017

National Provider Directory

National Provider Directory
Tax ID family
Moore Family Stores Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654128000000",
    "number": "1295810422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2245 W MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269367",
            "telephone_number": "217-362-6226",
            "fax_number": "217-362-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 E RIDGELAWN RD",
            "city": "MARTINSVILLE",
            "state": "IL",
            "postal_code": "624422551",
            "telephone_number": "217-382-4004",
            "fax_number": "217-382-3476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORE FAMILY STORES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TRENT",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "217-362-6226"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054020327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martinsville Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martinsville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.