NPIMap

Organization Active NPI

Meijer Inc.

  • Community/Retail Pharmacy
  • Stevensville, MI
National Provider Identifier
1710285754
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5315048982 Issued in MI
Legal business name
MEIJER INC.
Practice address
5019 Red Arrow Hwy
Stevensville, MI 49127-1013
Phone
(269) 556-2410
Fax
(269) 556-2465
NPI assigned
Feb 28, 2011
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jason Beauch, RPH
Title
Director of Pharmacy Managed Care
Phone
(616) 791-3169

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
23D2023638Meijer Pharmacy #2515019 Red Arrow Highway, Stevensville, MI 49127Certificate of waiverApr 27, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Inc5019 Red Arrow Hwy, Stevensville, MI 49127-1013(269) 556-2410 Epoetin|Immunosuppressive 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, 1998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071022000424 MI Part B Supplier - Mass Immunization (Roster Biller Only) 8325015639 This NPI is an additional NPI on the enrollment
O20110824000441 MI DME Supplier - PharmacyDME Supplier - Department StoreDME Supplier - Grocery Store 8325015639 Practice locations: Stevensville, MI

National Provider Directory

National Provider Directory
Tax ID family
Meijer127 organizations share this tax ID, including this one

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.

View all 24

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5315048982 MI
Community/Retail Pharmacy 3336C0003X 5315048982 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

5019 Red Arrow Hwy
Stevensville, MI 49127-1013

Mailing address

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

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
1710285754MedicaidMI
201191590AMedicaidIN

Other names 1

NPPES NPI Registry
  • Meijer Pharmacy #251 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 25, 2014.

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395705600000",
    "number": "1710285754",
    "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": "5019 RED ARROW HWY",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491271013",
            "telephone_number": "269-556-2410",
            "fax_number": "269-556-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2014-03-25",
        "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": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5315048982",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5315048982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710285754",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201191590A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #251",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stevensville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.