Active NPI
Roundys Supermarkets Inc
- Community/Retail Pharmacy
- Bloomingdale, IL
National Provider Identifier
1669915005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- ROUNDYS SUPERMARKETS INC
- Practice address
- 144 S Gary Ave
Bloomingdale, IL 60108-2225 - Phone
- (630) 671-9138
- Fax
- (630) 671-9235
- NPI assigned
- Dec 1, 2016
- 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
- William Dowling
- Title
- Vice President
- Phone
- (414) 231-5000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
144 S Gary Ave
Bloomingdale, IL 60108-2225
Mailing address
PO Box 473
Milwaukee, WI 53201-0473
Phone (414) 231-5000
Other names 1
- MARIANOS PHARMACY #8540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110329000044 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698858470 |
41 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Skokie, IL; Harwood Heights, IL; Hoffman Estates, IL; Lake Zurich, IL; Lombard, IL; Gurnee, IL; Naperville, IL; Northbrook, IL… |
Other NPIs on the same Medicare enrollment 41
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- Hoffman Estates, IL
- NPI 1134484389
O20110329000044
National Provider Directory
National Provider DirectoryMember of 3
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": "1480550400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1480550400000",
"number": "1669915005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 473",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532010473",
"telephone_number": "414-231-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 S GARY AVE",
"city": "BLOOMINGDALE",
"state": "IL",
"postal_code": "601082225",
"telephone_number": "630-671-9138",
"fax_number": "630-671-9235"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROUNDYS SUPERMARKETS INC",
"organizational_subpart": "NO",
"enumeration_date": "2016-12-01",
"last_updated": "2016-12-01",
"status": "A",
"authorized_official_last_name": "DOWLING",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "414-231-5000"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "MARIANOS PHARMACY #8540",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bloomingdale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.