Active NPI
GG II Indiana, LLC
- Pharmacy
- Indianapolis, IN
National Provider Identifier
1922574573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- GG II INDIANA, LLC
- Practice address
- 320 N New Jersey St
Indianapolis, IN 46204-2113 - Phone
- (463) 203-5178
- Fax
- (317) 423-2305
- NPI assigned
- Oct 22, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Joanna Bergum
- Title
- Director of Pharmacy Operations
- Phone
- (317) 450-5335
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | Primary |
Addresses
Primary practice location
320 N New Jersey St
Indianapolis, IN 46204-2113
Mailing address
320 N New Jersey St
Indianapolis, IN 46204-2113
Phone (463) 203-5178
Other names 1
- Needler's Fresh Market Pharmacy #929
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191113000250 | IN | Part B Supplier - Mass Immunization (Roster Biller Only) | 4587925904 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Indianapolis, IN |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- GG II Indiana LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Retail Pharmacy
- Pendleton, IN
- NPI 1083494348
-
- Community/Retail Pharmacy
- Anderson, IN
- NPI 1407714306
-
- Community/Retail Pharmacy
- Lafayette, IN
- NPI 1700385663
Locations
320 N New Jersey St
Indianapolis, IN 46204
Phone (317) 262-2226
899 E Jefferson St
#929
Tipton, IN 46072
Phone (765) 551-4479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540166400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1565913600000",
"number": "1922574573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 N NEW JERSEY ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462042113",
"telephone_number": "463-203-5178",
"fax_number": "317-423-2305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 N NEW JERSEY ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462042113",
"telephone_number": "463-203-5178",
"fax_number": "317-423-2305"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GG II INDIANA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-10-22",
"last_updated": "2019-08-16",
"status": "A",
"authorized_official_last_name": "BERGUM",
"authorized_official_first_name": "JOANNA",
"authorized_official_title_or_position": "DIRECTOR OF PHARMACY OPERATIONS",
"authorized_official_telephone_number": "317-450-5335"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Needler's Fresh Market Pharmacy #929",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Needler's Fresh Market Pharmacy #929",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.