NPIMap

Organization Active NPI

Hometown Medical Supplies LLC

Doing business as Hometown Medical Supplies

  • Durable Medical Equipment & Medical Supplies
  • Stockton, CA
National Provider Identifier
1750040465
Registry record updated Oct 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
HOMETOWN MEDICAL SUPPLIES LLC
Doing business as
Hometown Medical Supplies
Reliable Medical
Practice address
3663 Arch Rd Ste 600
Stockton, CA 95215-8355
Phone
(209) 472-1136
Fax
(209) 472-1138
NPI assigned
Dec 9, 2021
Last updated
Oct 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2026

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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

3663 Arch Rd Ste 600
Stockton, CA 95215-8355

Mailing address

9495 Winnetka Ave N Ste 200
Brooklyn Park, MN 55445-1706
Phone (292) 528-2116

Other names 2

  • Hometown Medical Supplies Doing business as
  • Reliable Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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).

National Provider Directory

National Provider Directory
Tax ID family
Hometown Medical Supplies LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

3663 Arch Rd
Ste 600
Stockton, CA 95215

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": "1792540800000",
    "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": "554451706",
            "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": "3663 ARCH RD STE 600",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952158355",
            "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": "2026-10-21",
        "certification_date": "2026-10-21",
        "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 Oct 21, 2026; 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.