NPIMap

Organization Active NPI

Jerkins Inc

  • Community/Retail Pharmacy
  • Opelika, AL
National Provider Identifier
1851371033
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
101890 Issued in AL
Legal business name
JERKINS INC
Doing business as
Bubba's Medicine Shop
Practice address
512 2ND Ave
Opelika, AL 36801-4316
Phone
(334) 749-3426
Fax
(334) 742-0757
NPI assigned
Jan 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Jeff Jerkins
Title
Pharmacist/New Owner
Phone
(334) 749-3426

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 101890 AL Primary

Addresses

Primary practice location

512 2ND Ave
Opelika, AL 36801-4316

Mailing address

512 2ND Ave
Opelika, AL 36801-4316
Phone (334) 749-3426

Other identifiers 3

IdentifierTypeStateIssuer
125867MedicaidAL
2123486OtherPK
117023MedicaidAL

Other names 1

  • Bubba's Medicine Shop Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101227000399 AL DME Supplier - PharmacyDME Supplier - Orthotic Personnel 9436347044 Practice locations: Opelika, AL
O20110303000979 AL Part B Supplier - Mass Immunization (Roster Biller Only) 9436347044 1 other NPI on this enrollment
Practice locations: Opelika, AL

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Bubba'S Medicine Shop4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1137888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1851371033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 2ND AVE",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368014316",
            "telephone_number": "334-749-3426",
            "fax_number": "334-742-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 2ND AVE",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368014316",
            "telephone_number": "334-749-3426",
            "fax_number": "334-742-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERKINS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-22",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "JERKINS",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PHARMACIST/NEW OWNER",
        "authorized_official_telephone_number": "334-749-3426"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "101890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125867",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123486",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117023",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bubba's Medicine Shop",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bubba's Medicine Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Opelika, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.