NPIMap

Organization Active NPI

Nudak Ventures LLC

  • Community/Retail Pharmacy
  • Traer, IA
National Provider Identifier
1497766901
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
467 Issued in IA
Legal business name
NUDAK VENTURES LLC
Practice address
500 2ND St
Traer, IA 50675-1139
Phone
(319) 478-8711
Fax
(319) 478-2501
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Authorized official

Name
Lori Ann Willis
Title
Acquisitions Manager
Phone
(641) 366-3440

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 467 IA Primary

Addresses

Primary practice location

500 2ND St
Traer, IA 50675-1139

Mailing address

PO Box 640
Conrad, IA 50621-0640
Phone (641) 366-3440

Other identifiers 2

IdentifierTypeStateIssuer
0180950MedicaidIA
2136169OtherPK

Other names 1

  • NuCara 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
O20131111001001 IA Part B Supplier - Mass Immunization (Roster Biller Only) 5395907141 23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conrad, IA; Ackley, IA; Zearing, IA; West Union, IA; Waterloo, IA; Traer, IA; Story City, IA; Pleasant Hill, IA…
O20220419002811 IA Part B Supplier - Independent Clinical Laboratory 5395907141 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Zearing, IA; West Union, IA; Waterloo, IA; Traer, IA; Story City, IA; Pleasant Hill, IA; Ottumwa, IA; Nevada, IA…

Other NPIs on the same Medicare enrollment 16

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

View all 16

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": "1491868800000",
    "number": "1497766901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "CONRAD",
            "state": "IA",
            "postal_code": "506210640",
            "telephone_number": "641-366-3440",
            "fax_number": "641-366-3442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 2ND ST",
            "city": "TRAER",
            "state": "IA",
            "postal_code": "506751139",
            "telephone_number": "319-478-8711",
            "fax_number": "319-478-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUDAK VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LORI ANN",
        "authorized_official_title_or_position": "ACQUISITIONS MANAGER",
        "authorized_official_telephone_number": "641-366-3440"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0180950",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136169",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NuCara Pharmacy #12",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traer, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.