NPIMap

Organization Active NPI

Amery Regional Medical Center, Inc

Doing business as Amery Community Pharmacy

  • Community/Retail Pharmacy
  • Amery, WI
National Provider Identifier
1891387502
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
AMERY REGIONAL MEDICAL CENTER, INC
Doing business as
Amery Community Pharmacy
Practice address
265 Griffin St E
Amery, WI 54001-1439
Phone
(715) 268-0678
Fax
(715) 268-0679
NPI assigned
Feb 4, 2021
Last updated
Feb 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Authorized official

Name
Debra Annelfstrom Rudquist
Title
Ceo/President
Phone
(715) 268-0300

Specialties & licenses 2

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

Addresses

Primary practice location

265 Griffin St E
Amery, WI 54001-1439

Mailing address

265 Griffin St E
Amery, WI 54001-1439
Phone (715) 268-0678

Other identifiers 1

IdentifierTypeStateIssuer
9660-42OtherWIWI BOARD PHARMACY LICENSE

Other names 1

  • Amery Community Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210317001204 WI DME Supplier - Pharmacy 2769391960 Practice locations: Amery, WI

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Apple River Hosptial6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1891387502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 GRIFFIN ST E",
            "city": "AMERY",
            "state": "WI",
            "postal_code": "540011439",
            "telephone_number": "715-268-0678",
            "fax_number": "715-268-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 GRIFFIN ST E",
            "city": "AMERY",
            "state": "WI",
            "postal_code": "540011439",
            "telephone_number": "715-268-0678",
            "fax_number": "715-268-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERY REGIONAL MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "RUDQUIST",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANNELFSTROM",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "715-268-0300"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI BOARD PHARMACY LICENSE",
            "identifier": "9660-42",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amery Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amery, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.