NPIMap

Individual provider Active NPI

Sarah Mathieu

  • Pharmacist
  • Ottawa, IL
National Provider Identifier
1528604642
Registry record updated Nov 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051.291192 Issued in IL
Practice address
2701 Columbus St
Ottawa, IL 61350-1005
Phone
(815) 434-1395
Fax
(815) 434-1396
NPI assigned
Nov 24, 2019
Last updated
Nov 24, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051.291192 IL Primary

Addresses

Primary practice location

2701 Columbus St
Ottawa, IL 61350-1005

Mailing address

2701 Columbus St
Ottawa, IL 61350-1005
Phone (815) 434-1395

Other identifiers 1

IdentifierTypeStateIssuer
311569568704MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sarah.mathieu@stores.kroger.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
051.291192ILMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Limited Partnership I PastSince Dec 1, 2019 Accepting new patients
Kroger Limited Partnership I PastSince Dec 1, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1574553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574553600000",
    "number": "1528604642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 COLUMBUS ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501005",
            "telephone_number": "815-434-1395",
            "fax_number": "815-434-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 COLUMBUS ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501005",
            "telephone_number": "815-434-1395",
            "fax_number": "815-434-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIEU",
        "first_name": "SARAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-24",
        "last_updated": "2019-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.291192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311569568704",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sarah.mathieu@stores.kroger.com",
            "affiliation": "N",
            "address_1": "2701 Columbus St",
            "city": "Ottawa",
            "state": "IL",
            "country_code": "US",
            "postal_code": "613501005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.