NPIMap

Highland Park CVS, L.L.C.

Organization Active NPI Pharmacy · Salem, IL

NPI 1720181597 · NPPES record last updated Dec 20, 2022

Key facts

NPI
1720181597
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
054-011772 (IL)
Legal business name
HIGHLAND PARK CVS, L.L.C.
Practice address
1022 W Main St
Salem, IL 62881-2929
Phone
(618) 548-5300
NPI assigned
Sep 7, 2006
Organization subpart
No

Authorized official

Name
Susan F Colbert
Title
Director, Payer Relations
Phone
(401) 770-2751

Corporate family (same tax ID) 24

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

Member of 1

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

Practitioners 4

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
CVS Pharmacy # 06389
1022 W Main Street, Salem, IL 62881 · (618) 548-5300		 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… Accepts assignment
Participating since Jan 1, 2023

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080103000235 IL Part B Supplier - Mass Immunization (Roster Biller Only) 2860572856 This NPI is an additional NPI on the enrollment
O20100930046056 IL DME Supplier - Pharmacy 2860572856 Practice locations: Salem, IL

National Provider Directory

Tax ID family
Highland Park CVS LLC (309 organizations share this tax ID)

Locations

1022 W Main St
Salem, IL 62881
Phone (618) 548-5300

402 E Main St
Salem, IL 62881
Phone (618) 548-5300

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 054-011772 IL Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1022 W Main St
Salem, IL 62881-2929

Mailing address

1 CVS Dr
PO Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers

IdentifierTypeStateIssuer
1440534OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names

  • CVS PHARMACY #06389 Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2022.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1720181597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "PO BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 W MAIN ST",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628812929",
            "telephone_number": "618-548-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND PARK CVS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054-011772",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1440534",
            "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 Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CVS PHARMACY #06389",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CVS PHARMACY #06389",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, IL

All providers in Salem, IL · Pharmacy in Illinois

Sources for this page

Verify at the official NPI Registry.