Active NPI
Highland Park CVS, L.L.C
Doing business as CVS Pharmacy #10761
- Community/Retail Pharmacy
- Wilmington, IL
National Provider Identifier
1649355660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 054-007797
- Legal business name
- HIGHLAND PARK CVS, L.L.C
- Doing business as
- CVS Pharmacy #10761
- Practice address
- 1101 S. Water St.
Wilmington, IL 60481 - Phone
- (815) 476-2131
- Fax
- (815) 476-2142
- NPI assigned
- Oct 26, 2006
- Last updated
- Jul 21, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Colbert
- Title
- Sr. Dr. Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 203000690 | IL | |
| Community/Retail Pharmacy | 3336C0003X | 054-007797 | IL | Primary |
Addresses
Primary practice location
1101 S. Water St.
Wilmington, IL 60481
Mailing address
1 CVS Dr
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 054-007797 | Other | IL | PHARMACY LIC |
| 14-06049 | Other | NABP | |
| 363484164018 | Medicaid | IL |
Other names 1
- CVS Pharmacy #10761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080103000235 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2860572856 | This NPI is an additional NPI on the enrollment |
| O20180102001955 | IL | DME Supplier - Pharmacy | 2860572856 | Practice locations: Wilmington, IL |
Laboratory certificates & supplier records
Derived by NPIMapThese 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
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Highland Park CVS LLC | Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Highland Park CVS LLC
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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1649355660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DR",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 S. WATER ST.",
"city": "WILMINGTON",
"state": "IL",
"postal_code": "60481",
"telephone_number": "815-476-2131",
"fax_number": "815-476-2142"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HIGHLAND PARK CVS, L.L.C",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-26",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR. DR. PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "IL",
"license": "203000690",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IL",
"license": "054-007797",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LIC",
"identifier": "054-007797",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NABP",
"identifier": "14-06049",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "363484164018",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #10761",
"code": "3",
"type": "Doing Business As"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.