NPIMap

Organization Active NPI

Covenant Medical Center Inc

Doing business as MercyOne Jesup Pharmacy

  • Community/Retail Pharmacy
  • Jesup, IA
National Provider Identifier
1922045632
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
432 Issued in IA
Legal business name
COVENANT MEDICAL CENTER INC
Doing business as
MercyOne Jesup Pharmacy
Practice address
1094 220TH St
Jesup, IA 50648-9400
Phone
(319) 827-6889
Fax
(319) 827-2324
NPI assigned
Jun 1, 2006
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Timothy Huber
Title
Controller
Phone
(319) 272-7607

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 432 IA Primary

Addresses

Primary practice location

1094 220TH St
Jesup, IA 50648-9400

Mailing address

2710 Saint Francis Dr
Suite 101
Waterloo, IA 50702-5619
Phone (319) 272-5277

Other identifiers 2

IdentifierTypeStateIssuer
2130097OtherPK
0126862MedicaidIA

Other names 1

  • MercyOne Jesup Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111013000167 IA DME Supplier - Pharmacy 0244148732 Practice locations: Jesup, IA
O20141015000916 IA Part B Supplier - Mass Immunization (Roster Biller Only) 0244148732 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jesup, IA; Waterloo, IA; La Porte City, IA

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 2

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

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
Mercyone Jesup Pharmacy1094 220TH Street, Jesup, IA 50648-9400(319) 827-6889 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jul 17, 1990

National Provider Directory

National Provider Directory
Tax ID family
Lee O Fagre MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

2101 Kimball Ave
Ste LL1
Waterloo, IA 50702

Practitioners & affiliated clinicians

Practitioners 1

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": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1922045632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 SAINT FRANCIS DR",
            "address_2": "SUITE 101",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025619",
            "telephone_number": "319-272-5277",
            "fax_number": "319-272-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1094 220TH ST",
            "city": "JESUP",
            "state": "IA",
            "postal_code": "506489400",
            "telephone_number": "319-827-6889",
            "fax_number": "319-827-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "HUBER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "319-272-7607"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2130097",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0126862",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MercyOne Jesup Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jesup, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.