NPIMap

Organization Active NPI

Mercy Health System Corporation

Doing business as Mercy Woodstock Pharmacy

  • Pharmacy
  • Woodstock, IL
National Provider Identifier
1366536773
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
54014068 Issued in IL
Legal business name
MERCY HEALTH SYSTEM CORPORATION
Doing business as
Mercy Woodstock Pharmacy
Practice address
2000 Lake Ave
Woodstock, IL 60098-7401
Phone
(815) 337-4116
Fax
(815) 337-4795
NPI assigned
Oct 3, 2006
Last updated
Jun 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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

Authorized official

Name
Jospeh D Malas
Title
Cfo
Phone
(815) 971-6738

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 54014068 IL Primary
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

2000 Lake Ave
Woodstock, IL 60098-7401

Mailing address

1010 N Washington St
Janesville, WI 53548-1561

Other names 1

  • MERCY WOODSTOCK PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930065590 IL DME Supplier - Pharmacy 7416860440 1 other NPI on this enrollment
Practice locations: Woodstock, IL
O20131106001193 IL Part B Supplier - Mass Immunization (Roster Biller Only) 7416860440 Practice locations: Woodstock, IL

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Dedham Medical Associat16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1366536773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N WASHINGTON ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535481561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 LAKE AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987401",
            "telephone_number": "815-337-4116",
            "fax_number": "815-337-4795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH SYSTEM CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HEALTH CORPORATION",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "MALAS",
        "authorized_official_first_name": "JOSPEH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "815-971-6738"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "54014068",
            "primary": true
        },
        {
            "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": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY WOODSTOCK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MERCY WOODSTOCK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; 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.