NPIMap

Organization Active NPI

Highland Park CVS, L.L.C.

Doing business as CVS Pharmacy #18063

  • Community/Retail Pharmacy
  • Waterloo, IL
National Provider Identifier
1902832256
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HIGHLAND PARK CVS, L.L.C.
Doing business as
CVS Pharmacy #18063
Schnucks Pharmacy 243
Practice address
150 Waterloo Commons Dr
Waterloo, IL 62298-1081
Phone
(618) 939-3942
Fax
(618) 939-3943
NPI assigned
Jun 25, 2006
Last updated
Jul 14, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SCHNUCK MARKETS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Authorized official

Name
Susan F Colbert
Title
Sr. Director, Payer Relations
Phone
(401) 770-2751

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WD0400X
Medical Specialty Clinic/Center 261QM2500X
Durable Medical Equipment & Medical Supplies 332B00000X 05412055 IL
Pharmacy 333600000X 05412055 IL
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

150 Waterloo Commons Dr
Waterloo, IL 62298-1081

Mailing address

1 CVS Dr # 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other identifiers 2

IdentifierTypeStateIssuer
1465839OtherOTHER ID NUMBER-COMMERCIAL NUMBER
430726776242MedicaidIL

Other names 2

  • CVS Pharmacy #18063 Doing business as
  • SCHNUCKS PHARMACY 243 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080103000235 IL Part B Supplier - Mass Immunization (Roster Biller Only) 2860572856 This NPI is an additional NPI on the enrollment
O20201021000350 IL DME Supplier - Pharmacy 2860572856 Practice locations: Waterloo, IL

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Highland Park CVS LLC150 Waterloo Commons Dr, Waterloo, IL 62298-1081(618) 939-3942 Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Ostomy Supplies|Urologic… Accepts assignmentParticipating since Jan 1, 2023

National Provider Directory

National Provider Directory
Tax ID family
Highland Park CVS LLC309 organizations share this tax ID, including this one
Part of
Schnucks Pharmacy

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

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

Locations

150 Waterloo Commons Dr
Waterloo, IL 62298
Phone (618) 939-3942

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.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1902832256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR # 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 WATERLOO COMMONS DR",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981081",
            "telephone_number": "618-939-3942",
            "fax_number": "618-939-3943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND PARK CVS, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCHNUCK MARKETS INC",
        "enumeration_date": "2006-06-25",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR. DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "05412055",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "05412055",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1465839",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "430726776242",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CVS Pharmacy #18063",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SCHNUCKS PHARMACY 243",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; 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.