Active NPI
Hometown Medical Supplies LLC
- Durable Medical Equipment & Medical Supplies
- Stockton, CA
National Provider Identifier
1750040465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- HOMETOWN MEDICAL SUPPLIES LLC
- Practice address
- 4873 West LN Ste C
Stockton, CA 95210-4548 - Phone
- (209) 472-1136
- Fax
- (209) 472-1138
- NPI assigned
- Dec 9, 2021
- 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
- Kiley Ann Russell
- Title
- Senior Director of Payor Relations
- Phone
- (629) 252-8211
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary | ||
| Customized Equipment (DME) | 332BC3200X |
Addresses
Primary practice location
4873 West LN Ste C
Stockton, CA 95210-4548
Mailing address
9495 Winnetka Ave N Ste 200
Brooklyn Park, MN 55445-1618
Phone (292) 528-2116
Other names 2
- Hometown Medical Supplies
- Reliable Medical
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230111002454 | CA | DME Supplier - Medical Supply Company | 5597960013 | Practice locations: Stockton, CA |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Durable Medical Equipment & Medical Supplies
- Visalia, CA
- NPI 1073251872
5597960013
-
- Durable Medical Equipment & Medical Supplies
- Santa Rosa, CA
- NPI 1104559236
5597960013
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 |
|---|---|---|
| Hometown Medical Supplies LLC | Commodes, Urinals, Bedpans|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Canes and/or Crutches|Patient Lifts|Power Operated Vehicles (Scooters)|Walkers|Wheelchairs (Standard Manual)|Wheelchairs (Standard Manual Related Accessories)|Wheelchairs (S… | Does not accept assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Hometown Medical Supplies LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Visalia, CA
- NPI 1073251872
-
- Durable Medical Equipment & Medical Supplies
- Santa Rosa, CA
- NPI 1104559236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639008000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1780531200000",
"number": "1750040465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9495 WINNETKA AVE N STE 200",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554451618",
"telephone_number": "292-528-2116",
"fax_number": "763-255-3972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4873 WEST LN STE C",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952104548",
"telephone_number": "209-472-1136",
"fax_number": "209-472-1138"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOMETOWN MEDICAL SUPPLIES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-12-09",
"last_updated": "2026-06-04",
"certification_date": "2026-06-04",
"status": "A",
"authorized_official_last_name": "RUSSELL",
"authorized_official_first_name": "KILEY",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "SENIOR DIRECTOR OF PAYOR RELATIONS",
"authorized_official_telephone_number": "629-252-8211"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
},
{
"code": "332BC3200X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Hometown Medical Supplies",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Reliable Medical",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; 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.