NPIMap

Organization Active NPI

Meijer Great Lakes Limited Partnership

Doing business as Meijer Pharmacy #289

  • Community/Retail Pharmacy
  • Round Lake Beach, IL
National Provider Identifier
1891159455
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Doing business as
Meijer Pharmacy #289
Practice address
750 E Rollins Rd
Round Lake Beach, IL 60073-1340
Phone
(847) 210-0810
Fax
(847) 201-0765
NPI assigned
Apr 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Authorized official

Name
Jason Beauch, R.PHNPI 1518380062
Title
VP of Pharmacy Merchandising
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)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

750 E Rollins Rd
Round Lake Beach, IL 60073-1340

Mailing address

2929 Walker Ave NW
Grand Rapids, MI 49544-6402
Phone (616) 791-3169

Other names 1

  • Meijer Pharmacy #289 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121008000019 IL Part B Supplier - Mass Immunization (Roster Biller Only) 4385829480 25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: McHenry, IL; Plainfield, IL; Mokena, IL; Normal, IL; Orland Park, IL; Oswego, IL; Rockford, IL; Rolling Meadows, IL…
O20161013001722 IL DME Supplier - Pharmacy 4385829480 Practice locations: Round Lake Beach, IL

Other NPIs on the same Medicare enrollment 25

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

View all 25

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2112269Meijer Pharmacy #289750 E Rollins Rd, Round Lake Beach, IL 60073Certificate of waiverApr 25, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Meijer Great Lakes Limited Partners750 E Rollins Rd, Round Lake Beach, IL 60073-1340(847) 201-0810 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers Does not accept assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Meijer37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Member of 2

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

Locations

7111 Cermak Rd
Berwyn, IL 60402
Phone (708) 795-3810

7111 Cermak Rd
#264
Berwyn, IL 60402
Phone (708) 795-3810

990 N Bradley Blvd
Bradley, IL 60915
Phone (779) 301-8210

815 S Randall Rd
Elgin, IL 60123
Phone (847) 608-7380

950 Winston Plz
Melrose Park, IL 60160
Phone (708) 338-5664

950 Winston Plz
#263
Melrose Park, IL 60160
Phone (708) 338-5664

9000 W Golf Rd
Niles, IL 60714
Phone (847) 635-2200

9000 W Golf Rd
#261
Niles, IL 60714
Phone (847) 635-2210

15701 S 71st Ct
Orland Park, IL 60462
Phone (708) 342-9900

2700 US Highway 34
Oswego, IL 60543
Phone (630) 554-4850

13521 S Route 59
Plainfield, IL 60544
Phone (815) 267-8010

2013 McFarland Rd
Rockford, IL 61107
Phone (815) 397-1557

855 S Randall Rd
St Charles, IL 60174
Phone (630) 587-2700

1676 Westpark Dr
Bowling Green, KY 42104
Phone (270) 495-6710

4990 Houston Rd
Florence, KY 41042
Phone (859) 746-6310

351 Meijer Way
Ste 100
Lexington, KY 40503
Phone (859) 219-3700

4100 Towne Center Dr
Louisville, KY 40241
Phone (502) 326-5200

9905 Dixie Hwy
Louisville, KY 40272
Phone (502) 995-2100

Practitioners & affiliated clinicians

Practitioners 11

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": "1460332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614211200000",
    "number": "1891159455",
    "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": "495446402",
            "telephone_number": "616-791-3169",
            "fax_number": "616-793-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ROLLINS RD",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600731340",
            "telephone_number": "847-210-0810",
            "fax_number": "847-201-0765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEIJER GREAT LAKES LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-11",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "BEAUCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "VP OF PHARMACY MERCHANDISING",
        "authorized_official_telephone_number": "616-791-3169",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meijer Pharmacy #289",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meijer Pharmacy #289",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Lake Beach, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; 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.

Verify at the official NPI Registry.