Active NPI
Walmart Inc.
- Community/Retail Pharmacy
- Leavenworth, KS
National Provider Identifier
1740207141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 2-10246
- Legal business name
- WALMART INC.
- Practice address
- 5000 10TH Ave
Leavenworth, KS 66048-5514 - Phone
- (913) 651-4070
- NPI assigned
- Jul 16, 2006
- 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
- Matthew McMullin
- Title
- Director, Contracting
- Phone
- (479) 371-8711
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2-10246 | KS | Primary |
Addresses
Primary practice location
5000 10TH Ave
Leavenworth, KS 66048-5514
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2032402 | Other | PK | |
| 100433230A | Medicaid | KS | |
| 6010831814 | Medicaid | KS |
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 KS
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930000599 | KS | DME Supplier - Pharmacy | 4385556745 | Practice locations: Leavenworth, KS |
| O20131011000473 | KS | Part B Supplier - Mass Immunization (Roster Biller Only) | 4385556745 |
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.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Wal-Mart Pharmacy 10-0026 | 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
- Ability Network
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.
-
- Optician
- Dodge City, KS
- NPI 1760259600
-
- Optician
- Topeka, KS
- NPI 1790566354
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": "1699228800000",
"number": "1740207141",
"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": "5000 10TH AVE",
"city": "LEAVENWORTH",
"state": "KS",
"postal_code": "660485514",
"telephone_number": "913-651-4070"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALMART INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-16",
"last_updated": "2023-11-06",
"certification_date": "2023-11-06",
"status": "A",
"authorized_official_last_name": "MCMULLIN",
"authorized_official_first_name": "MATTHEW",
"authorized_official_title_or_position": "DIRECTOR, CONTRACTING",
"authorized_official_telephone_number": "479-371-8711"
},
"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": "KS",
"license": "2-10246",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2032402",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100433230A",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6010831814",
"state": "KS"
}
],
"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",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031505",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Leavenworth, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.