NPIMap

Organization Active NPI

Mercy Health System Corporation

Doing business as Mercy Walworth Pharmacy

  • Pharmacy
  • Lake Geneva, WI
National Provider Identifier
1851327639
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
8097 Issued in WI
Legal business name
MERCY HEALTH SYSTEM CORPORATION
Doing business as
Mercy Walworth Pharmacy
Practice address
N2950 State Road 67
Lake Geneva, WI 53147-2655
Phone
(262) 245-2319
Fax
(262) 245-4995
NPI assigned
Jun 24, 2006
Last updated
Sep 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Authorized official

Name
Don Janczak, PHARMDNPI 1558356998
Title
Director of Pharmacy
Phone
(608) 756-6664

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)CodeLicenseStatePrimary
Pharmacy 333600000X 8097 WI Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

N2950 State Road 67
Lake Geneva, WI 53147-2655

Mailing address

1010 N Washington St
Janesville, WI 53548-1561

Other identifiers 2

IdentifierTypeStateIssuer
33257100MedicaidWI
5126570OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • MERCY WALWORTH PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930027703 WI DME Supplier - Pharmacy 7416860440 Practice locations: Lake Geneva, WI
O20130827000411 WI Part B Supplier - Mass Immunization (Roster Biller Only) 7416860440 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Janesville, WI; Lake Geneva, WI; Milton, WI

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Genesis Counseling SVC16 organizations share this tax ID, including this one
Part of
Genesis Counseling SVC

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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.

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695772800000",
    "number": "1851327639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N WASHINGTON ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535481561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2950 STATE ROAD 67",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472655",
            "telephone_number": "262-245-2319",
            "fax_number": "262-245-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH SYSTEM CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HEALTH SYSTEM",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A",
        "authorized_official_last_name": "JANCZAK",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "608-756-6664",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "8097",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33257100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5126570",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY WALWORTH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MERCY WALWORTH PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Geneva, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; 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.