NPIMap

Organization Active NPI

Niemann Foods Inc

Doing business as County Market Pharmacy 458

  • Community/Retail Pharmacy
  • Lewistown, IL
National Provider Identifier
1841558012
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054017962 Issued in IL
Legal business name
NIEMANN FOODS INC
Doing business as
County Market Pharmacy 458
Practice address
518 S Main St
Lewistown, IL 61542-1565
Phone
(309) 547-3731
Fax
(309) 547-2040
NPI assigned
Apr 25, 2012
Last updated
Nov 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Christopher Niemann
Title
Evp/Cfo
Phone
(217) 221-5615

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054017962 IL Primary

Addresses

Primary practice location

518 S Main St
Lewistown, IL 61542-1565

Mailing address

PO Box 847
Quincy, IL 62306-0847
Phone (217) 221-5615

Other identifiers 1

IdentifierTypeStateIssuer
2134858OtherPK

Other names 1

  • County Market Pharmacy 458 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211006002600 IL Part B Supplier - Mass Immunization (Roster Biller Only) 6103032206 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Champaign, IL; Springfield, IL; Pittsfield, IL; Rushville, IL; Chatham, IL; Lewistown, IL

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

1501 N 12th St
Quincy, IL 62301
Phone (217) 221-5615

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1841558012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623060847",
            "telephone_number": "217-221-5615",
            "fax_number": "217-221-5915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 S MAIN ST",
            "city": "LEWISTOWN",
            "state": "IL",
            "postal_code": "615421565",
            "telephone_number": "309-547-3731",
            "fax_number": "309-547-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIEMANN FOODS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "NIEMANN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "217-221-5615"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054017962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134858",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "County Market Pharmacy 458",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "County Market Pharmacy 458",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewistown, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; 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.