NPIMap

Organization Active NPI

Kroger Limited Partnership I

  • Community/Retail Pharmacy
  • Taylorville, IL
National Provider Identifier
1871666495
Registry record updated Dec 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054015081 Issued in IL
Legal business name
KROGER LIMITED PARTNERSHIP I
Practice address
201 E Bidwell St
Taylorville, IL 62568-1361
Phone
(217) 287-7391
Fax
(217) 287-7440
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2009

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

Authorized official

Name
Matt Mineer
Title
Interface Manager
Phone
(513) 387-7074

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 054015081 IL Primary

Addresses

Primary practice location

201 E Bidwell St
Taylorville, IL 62568-1361

Mailing address

5960 Castleway West Dr
Indianapolis, IN 46250-1977
Phone (317) 579-8434

Other identifiers 1

IdentifierTypeStateIssuer
1476452OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • KROGER PHARMACY J-888 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081104000404 IL Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Streator, IL; Anna, IL; Washington, IL; Peoria, IL; Pekin, IL; Ottawa, IL; Normal, IL; Murphysboro, IL…

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260748800000",
    "number": "1871666495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 CASTLEWAY WEST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501977",
            "telephone_number": "317-579-8434",
            "fax_number": "317-579-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E BIDWELL ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625681361",
            "telephone_number": "217-287-7391",
            "fax_number": "217-287-7440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2009-12-14",
        "status": "A",
        "authorized_official_last_name": "MINEER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "INTERFACE MANAGER",
        "authorized_official_telephone_number": "513-387-7074"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054015081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1476452",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY J-888",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylorville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; 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.