NPIMap

Organization Active NPI

Meijer Great Lakes Limited Partnership

Doing business as Meijer Pharmacy #273

  • Community/Retail Pharmacy
  • Mokena, IL
National Provider Identifier
1649686056
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #273
Practice address
11305 Lincoln Rd.
Mokena, IL 60448-2070
Phone
(815) 277-0510
Fax
(815) 277-0565
NPI assigned
Jul 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Authorized official

Name
Jason Beauch, R.PH
Title
Director of Pharmacy Managed Care
Phone
(616) 791-3169

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X IL
Community/Retail Pharmacy 3336C0003X IL Primary

Addresses

Primary practice location

11305 Lincoln Rd.
Mokena, IL 60448-2070

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169

Other identifiers 1

IdentifierTypeStateIssuer
P01124565OtherILRAILROAD FLU

Other names 1

  • Meijer Pharmacy #273 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121008000019 IL Part B Supplier - Mass Immunization (Roster Biller Only) 4385829480 25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McHenry, IL; Plainfield, IL; Mokena, IL; Normal, IL; Orland Park, IL; Oswego, IL; Rockford, IL; Rolling Meadows, IL…
O20140909001803 IL DME Supplier - PharmacyDME Supplier - Grocery StoreDME Supplier - Department Store 4385829480 Practice locations: Mokena, IL

Other NPIs on the same Medicare enrollment 25

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

View all 25

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
14D2078301Meijer Pharmacy #27311305 Lincoln Highway, Mokena, IL 60448Certificate of waiverMay 26, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Great Lakes Limited Partners11305 Lincoln Rd, Mokena, IL 60448-2070(815) 277-0510 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers Does not accept assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Meijer37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Member of 1

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

Locations

11305 W Lincoln Hwy
Mokena, IL 60448
Phone (815) 277-0510

NPI Registry JSON

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614211200000",
    "number": "1649686056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 WALKER AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495446402",
            "telephone_number": "616-791-3169",
            "fax_number": "616-735-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11305 LINCOLN RD.",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604482070",
            "telephone_number": "815-277-0510",
            "fax_number": "815-277-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER GREAT LAKES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "BEAUCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY MANAGED CARE",
        "authorized_official_telephone_number": "616-791-3169",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD FLU",
            "identifier": "P01124565",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #273",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meijer Pharmacy #273",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; 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.