NPIMap

Organization Active NPI

Bode Drug Inc

  • Pharmacy
  • Vienna, IL
National Provider Identifier
1376572552
Registry record updated Apr 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
054018126 Issued in IL
Legal business name
BODE DRUG INC
Practice address
803 And One Half N First St
Vienna, IL 62995
Phone
(618) 658-3784
Fax
(618) 658-4070
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2013

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

Authorized official

Name
Carl Bode
Title
President
Phone
(618) 748-9253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 054018126 IL Primary

Addresses

Primary practice location

803 And One Half N First St
Vienna, IL 62995

Mailing address

803 And One Half N First St
Vienna, IL 62995
Phone (618) 658-3784

Other identifiers 1

IdentifierTypeStateIssuer
2139137OtherPK

Other names 1

  • BODE DRUG INC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130805000187 IL DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 3173641073 Practice locations: Vienna, IL
O20160513000419 IL Part B Supplier - Pharmacy 3173641073 1 other NPI on this enrollment
Practice locations: Mound City, IL; Vienna, IL

Other NPIs with the same Medicare PAC ID 1

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

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
Bode Drug Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1376572552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 AND ONE HALF N FIRST ST",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "62995",
            "telephone_number": "618-658-3784",
            "fax_number": "618-658-4070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 AND ONE HALF N FIRST ST",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "62995",
            "telephone_number": "618-658-3784",
            "fax_number": "618-658-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODE DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "BODE",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-748-9253"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054018126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2139137",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BODE DRUG INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vienna, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.