Walmart Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054017736 Issued in IL

Legal business name

WALMART INC.

Practice address

2415 N Bloomington St
Streator, IL 61364-1305

Phone

(815) 672-3517

NPI assigned

Aug 9, 2011

Organization subpart

No

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

Authorized official

Name

Sarah Little

Title

Director of Healthcare Contracting

Phone

(479) 277-2500

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

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

Tax ID family

Ability Network2,173 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Princeton, IL
  • NPI 1295816189
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Glen Ellyn, IL
  • NPI 1295816296
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Decatur, IL
  • NPI 1306929955
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Mattoon, IL
  • NPI 1326121559
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • East Peoria, IL
  • NPI 1326122409
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Springfield, IL
  • NPI 1326129347
  NPD tax ID
• Wal-Mart Stores, Inc

  • Optician
  • Crystal Lake, IL
  • NPI 1326229253
  NPD tax ID
• Wal-Mart Stores, Inc

  • Eyewear Supplier
  • Decatur, IL
  • NPI 1336223973
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Bradley, IL
  • NPI 1316116015
  NPD tax ID
• Wal-Mart Stores, Inc.

  • Optician
  • Jacksonville, IL
  • NPI 1336318021
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Princeton, IL
  • NPI 1275550535
  NPD tax ID
• Walmart Inc.

  • Community/Retail Pharmacy
  • Lincoln, IL
  • NPI 1295752566
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trent Ryan Weeks, PHARMD

  • Pharmacist
  • Streator, IL
  • NPI 1164022547
  NPD (past)

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1316226376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727166209",
            "telephone_number": "479-277-1238",
            "fax_number": "479-277-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 N BLOOMINGTON ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613641305",
            "telephone_number": "815-672-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTHCARE CONTRACTING",
        "authorized_official_telephone_number": "479-277-2500"
    },
    "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": "IL",
            "license": "054017736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131522",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Two Rivers Outreach
• U K Sinha, M.D., S.C.
• Jessica Anne Verduzco
• Walgreen Co
• Jessica Wallbaum
• Mark A Wargo, M.D.
• Marissa Dyanne Weaver, CRNA
• Trent Ryan Weeks, PHARMD
• Western Illinois ENT and Allergy
• Gary B. White, O.D.

• Community/Retail Pharmacy in Streator, IL
• Providers in Streator, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.