NPIMap

Organization Active NPI

Roundys Supermarkets Inc

  • Community/Retail Pharmacy
  • Chicago, IL
National Provider Identifier
1376974170
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054-018488 Issued in IL
Legal business name
ROUNDYS SUPERMARKETS INC
Practice address
3145 S Ashland Ave
Chicago, IL 60608-6251
Phone
(773) 247-3394
Fax
(773) 247-4159
NPI assigned
Dec 3, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Edward Kitz
Title
Group VP - Legal Risk & Treasury
Phone
(414) 231-5000

Other NPIs on the same Medicare enrollment 41

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

View all 41

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2036083Mariano'S Pharmacy #85203145 S Ashland Ave, Chicago, IL 60608Certificate of waiverJan 30, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Roundys Supermarkets Inc3145 S Ashland Ave, Chicago, IL 60608-6251(773) 247-3394 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplie… Accepts assignmentParticipating since Dec 18, 2023

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110329000044 IL Part B Supplier - Mass Immunization (Roster Biller Only) 5698858470 41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Skokie, IL; Harwood Heights, IL; Hoffman Estates, IL; Lake Zurich, IL; Lombard, IL; Gurnee, IL; Naperville, IL; Northbrook, IL…
O20140423000922 IL DME Supplier - Pharmacy 5698858470 Practice locations: Chicago, IL

National Provider Directory

National Provider Directory
Tax ID family
Mariano'S Pharmacy103 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.

View all 24

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054-018488 IL Primary

Addresses

NPPES NPI Registry

Primary practice location

3145 S Ashland Ave
Chicago, IL 60608-6251

Mailing address

PO Box 473
Ms-2870
Milwaukee, WI 53201-0473
Phone (414) 231-5523

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
2143422OtherPK

Other names 1

NPPES NPI Registry
  • MARIANO'S PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 8, 2014.

{
    "created_epoch": "1386028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410134400000",
    "number": "1376974170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 473",
            "address_2": "MS-2870",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532010473",
            "telephone_number": "414-231-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3145 S ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606086251",
            "telephone_number": "773-247-3394",
            "fax_number": "773-247-4159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUNDYS SUPERMARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-03",
        "last_updated": "2014-09-08",
        "status": "A",
        "authorized_official_last_name": "KITZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "GROUP VP - LEGAL RISK & TREASURY",
        "authorized_official_telephone_number": "414-231-5000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054-018488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143422",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIANO'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.