NPIMap

Organization Active NPI

Shopko Stores Operating Co. LLC

  • Eyewear Supplier
  • Mitchell, SD
National Provider Identifier
1750334181
Registry record updated Feb 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SHOPKO STORES OPERATING CO. LLC
Practice address
1900 N Main St
Mitchell, SD 57301-1160
Phone
(605) 996-7042
NPI assigned
May 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael J Bettiga, RPH
Title
Sr. Vice President Health Services
Phone
(920) 429-4297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

1900 N Main St
Mitchell, SD 57301-1160

Mailing address

1900 N Main St
Mitchell, SD 57301-1160
Phone (605) 996-7042

Other identifiers 4

IdentifierTypeStateIssuer
014022OtherVIP
213121-27OtherEYEMED
35517OtherAVESIS
17910OtherMEDICARE

Other names 1

  • ShopKo Optical 022 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060627000158 SD Part B Supplier - Clinic/Group Practice 0749292639 Receives reassigned benefits from 3 practitioners
6 other NPIs on this enrollment
Practice locations: Rapid City, SD; Watertown, SD; Sioux Falls, SD; Aberdeen, SD; Mitchell, SD

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Shopko Stores Operat Co LLC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

1900 N Main St
Mitchell, SD 57301
Phone (605) 996-6568

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1750334181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 N MAIN ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011160",
            "telephone_number": "605-996-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 N MAIN ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011160",
            "telephone_number": "605-996-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT HEALTH SERVICES",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIP",
            "identifier": "014022",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "213121-27",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "35517",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "17910",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Optical 022",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.