NPIMap

Organization Active NPI

B & R Stores, Inc

Doing business as Super Saver Pharmacy #12

  • Community/Retail Pharmacy
  • Council Bluffs, IA
National Provider Identifier
1376659078
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
972 Issued in IA
Legal business name
B & R STORES, INC
Doing business as
Super Saver Pharmacy #12
Practice address
1141 N Broadway
Council Bluffs, IA 51503-1513
Phone
(712) 322-9019
Fax
(712) 325-9731
NPI assigned
Aug 23, 2006
Last updated
Nov 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Authorized official

Name
Anthony Leo Schmid, PHARMD
Title
Director of Pharmacy
Phone
(402) 464-6297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 972 IA Primary

Addresses

Primary practice location

1141 N Broadway
Council Bluffs, IA 51503-1513

Mailing address

1141 N Broadway
Council Bluffs, IA 51503-1513
Phone (712) 322-9019

Other names 1

  • Super Saver Pharmacy #12 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930002313 IA DME Supplier - Pharmacy 0143349159 Practice locations: Council Bluffs, IA
O20111128000779 IA Part B Supplier - Mass Immunization (Roster Biller Only) 0143349159 2 other NPIs on this enrollment
Practice locations: Council Bluffs, IA

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

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
Super Saver Pharmacy #121141 N Broadway, Council Bluffs, IA 51503-1513(712) 322-9019 Blood Glucose Monitors/Supplies (Non-Mail Order)|Insulin Infusion Pumps and/or Supplies|Orthoses: Off-The-Shelf|Nebulizer Equipment and/or Supplies|Surgical Dressings Accepts assignmentParticipating since Aug 1, 2011

National Provider Directory

National Provider Directory
Tax ID family
BR Stores Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1376659078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 N BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031513",
            "telephone_number": "712-322-9019",
            "fax_number": "712-325-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 N BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515031513",
            "telephone_number": "712-322-9019",
            "fax_number": "712-325-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B & R STORES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "SCHMID",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "LEO",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "402-464-6297",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super Saver Pharmacy #12",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.