Active NPI
Sams East Inc
Doing business as Sam's Club Pharmacy 10-4939
- Community/Retail Pharmacy
- San Antonio, TX
National Provider Identifier
1649691478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 28986
- Legal business name
- SAMS EAST INC
- Doing business as
- Sam's Club Pharmacy 10-4939
- Practice address
- 3239 Goliad Rd
San Antonio, TX 78223-4608 - Phone
- (210) 507-0492
- NPI assigned
- Dec 20, 2013
- Last updated
- Aug 28, 2023
- 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
- Laura Levine
- Title
- Director Government Contractin
- Phone
- (479) 204-8550
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 28986 | TX | Primary |
Addresses
Primary practice location
3239 Goliad Rd
San Antonio, TX 78223-4608
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1242
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2143615 | Other | PK | |
| 469672 | Medicaid | TX | |
| 1649691478 | Medicaid | TX |
Other names 1
- Sam's Club Pharmacy 10-4939
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121015000528 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 7012038581 | This NPI is an additional NPI on the enrollment |
| O20140314001381 | TX | DME Supplier - Pharmacy | 7012038581 | Practice locations: San Antonio, TX |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2126271 | Sam's Club Pharmacy 10-4939 | Certificate of waiver | Feb 21, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Sam's Pharmacy 10-4939 | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Ostomy Supplies|Prosthetic Lenses: Conventional Eyeglasses|Enteral Nutrients|Surgical Dressings | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Sam's Hearing Aid Center 6332
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 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Sams Pharmacy 10-6254
- Community/Retail Pharmacy
- Maple Grove, MN
- NPI 1184641581
Member Of
-
dba Walmart Pharmacy 10-1588
- Community/Retail Pharmacy
- Victorville, CA
- NPI 1043237456
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387497600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1693180800000",
"number": "1649691478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160445",
"telephone_number": "479-277-1242",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3239 GOLIAD RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782234608",
"telephone_number": "210-507-0492"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS EAST INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-12-20",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A",
"authorized_official_last_name": "LEVINE",
"authorized_official_first_name": "LAURA",
"authorized_official_title_or_position": "DIRECTOR GOVERNMENT CONTRACTIN",
"authorized_official_telephone_number": "479-204-8550"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "28986",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2143615",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "469672",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1649691478",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St Ste 900A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Sam's Club Pharmacy 10-4939",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sam's Club Pharmacy 10-4939",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.