NPIMap

Organization Active NPI

Jac Stores Inc

Doing business as Sav Mor Pharmacy

  • Community/Retail Pharmacy
  • Paxton, IL
National Provider Identifier
1417968918
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054014499 Issued in IL
Legal business name
JAC STORES INC
Doing business as
Sav Mor Pharmacy
Practice address
138 N Market St
Paxton, IL 60957-1220
Phone
(217) 379-4855
Fax
(217) 379-9068
NPI assigned
Aug 10, 2006
Last updated
Oct 4, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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

Authorized official

Name
David Falk
Title
President & Owner
Phone
(217) 362-6226

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054014499 IL Primary

Addresses

Primary practice location

138 N Market St
Paxton, IL 60957-1220

Mailing address

PO Box 3040
Decatur, IL 62524-3040
Phone (217) 362-6226

Other identifiers 1

IdentifierTypeStateIssuer
1446031OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • SAV MOR PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100811000759 IL Part B Supplier - Mass Immunization (Roster Biller Only) 8921132051 13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nokomis, IL; Robinson, IL; Tuscola, IL; Virden, IL

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349308800000",
    "number": "1417968918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3040",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625243040",
            "telephone_number": "217-362-6226",
            "fax_number": "217-362-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 N MARKET ST",
            "city": "PAXTON",
            "state": "IL",
            "postal_code": "609571220",
            "telephone_number": "217-379-4855",
            "fax_number": "217-379-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAC STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2012-10-04",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT & OWNER",
        "authorized_official_telephone_number": "217-362-6226"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054014499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1446031",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAV MOR PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paxton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; 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.