Active NPI
Meijer Inc
Doing business as Meijer Pharmacy #209
- Community/Retail Pharmacy
- Dewitt, MI
National Provider Identifier
1790802601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301008554
- Legal business name
- MEIJER INC
- Doing business as
- Meijer Pharmacy #209
- Practice address
- 12821 Crossover Dr
Dewitt, MI 48820-7993 - Phone
- (517) 669-4610
- Fax
- (517) 669-4765
- NPI assigned
- Mar 23, 2007
- Last updated
- Mar 26, 2014
- 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
- Jason Beauch, RPH
- Title
- Director of Pharmacy Managed Care
- Phone
- (616) 791-3169
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 5301008554 | MI | |
| Community/Retail Pharmacy | 3336C0003X | 5301008554 | MI | Primary |
Addresses
Primary practice location
12821 Crossover Dr
Dewitt, MI 48820-7993
Mailing address
2929 Walker Ave NW
Grand Rapids, MI 49544-9424
Phone (616) 791-3169
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2369545 | Medicaid | MI |
Other names 1
- Meijer Pharmacy #209
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071022000424 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 8325015639 | This NPI is an additional NPI on the enrollment |
| O20100930047580 | MI | DME Supplier - Pharmacy | 8325015639 | Practice locations: Dewitt, MI |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1064600 | Meijer Pharmacy #209 | Certificate of waiver | Feb 8, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Meijer Pharmacy 150
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.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Grand Rapids, MI
- NPI 1518380062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1395792000000",
"number": "1790802601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 WALKER AVE NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495449424",
"telephone_number": "616-791-3169",
"fax_number": "616-735-8532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12821 CROSSOVER DR",
"city": "DEWITT",
"state": "MI",
"postal_code": "488207993",
"telephone_number": "517-669-4610",
"fax_number": "517-669-4765"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEIJER INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-23",
"last_updated": "2014-03-26",
"status": "A",
"authorized_official_last_name": "BEAUCH",
"authorized_official_first_name": "JASON",
"authorized_official_title_or_position": "DIRECTOR OF PHARMACY MANAGED CARE",
"authorized_official_telephone_number": "616-791-3169",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "MI",
"license": "5301008554",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301008554",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2369545",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Meijer Pharmacy #209",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dewitt, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; 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.