NPIMap

Organization Active NPI

Sams East Inc

Doing business as Sams Pharmacy 10-4876

  • Community/Retail Pharmacy
  • Bowling Green, KY
National Provider Identifier
1700803046
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07084 Issued in KY
Legal business name
SAMS EAST INC
Doing business as
Sams Pharmacy 10-4876
Practice address
3200 Ken Bale Blvd
Bowling Green, KY 42103-6025
Phone
(270) 781-7727
NPI assigned
Jul 16, 2006
Last updated
Aug 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WAL-MART STORES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Authorized official

Name
Laura Levine
Title
MGR of Government Contracting
Phone
(479) 204-8550

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X P07084 KY Primary

Addresses

Primary practice location

3200 Ken Bale Blvd
Bowling Green, KY 42103-6025

Mailing address

702 SW 8TH St
Bentonville, AR 72716-0445

Other identifiers 3

IdentifierTypeStateIssuer
54011317MedicaidKY
5401131700MedicaidKY
2034342OtherPK

Other names 1

  • SAMS PHARMACY 10-4876 Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
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 KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930021317 KY DME Supplier - Pharmacy 7012038581 Practice locations: Bowling Green, KY
O20130715000113 KY Part B Supplier - Mass Immunization (Roster Biller Only) 7012038581 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowling Green, KY; Paducah, KY; Owensboro, KY; Nicholasville, KY; Louisville, KY; Jeffersontown, KY; Florence, KY; Elizabethtown, KY…

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Sams Club Optical823 organizations share this tax ID, including this one
Part of
Walmart Pharmacy 10-206

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Member of 2

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

  • Sams West Inc

    dba Sams Pharmacy

    • Community/Retail Pharmacy
    • Hodgkins, IL
    • NPI 1760409056

    Member Of

    NPD member
  • Walmart Inc.

    dba Walmart Pharmacy 10-2050

    • Community/Retail Pharmacy
    • Henderson, NV
    • NPI 1043237142

    Member Of

    NPD member

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1700803046",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 KEN BALE BLVD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421036025",
            "telephone_number": "270-781-7727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMS EAST INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAL-MART STORES INC",
        "enumeration_date": "2006-07-16",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "MGR OF GOVERNMENT CONTRACTING",
        "authorized_official_telephone_number": "479-204-8550"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54011317",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5401131700",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2034342",
            "state": null
        }
    ],
    "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 # A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SAMS PHARMACY 10-4876",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAMS PHARMACY 10-4876",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.

Verify at the official NPI Registry.