Active NPI
Highland Park CVS, L.L.C.
Doing business as CVS Pharmcay # 04061
- Pharmacy
- Chicago, IL
National Provider Identifier
1972751014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- HIGHLAND PARK CVS, L.L.C.
- Doing business as
- CVS Pharmcay # 04061
- Practice address
- 520 S. State Street
Chicago, IL 60605 - Phone
- (312) 697-0021
- NPI assigned
- Sep 3, 2008
- Last updated
- Oct 8, 2014
- 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
- Cristiana Mauricio
- Title
- MGR Phcy Enrollments
- Phone
- (401) 765-1500
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | Primary | |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
520 S. State Street
Chicago, IL 60605
Mailing address
One CVS Drive
Box 1075 - Pharmacy Enrollments
Woonsocket, RI 02895
Phone (401) 765-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1482443 | Other | IL | NCPDP |
Other names 1
- CVS Pharmcay # 04061
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080103000235 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2860572856 | This NPI is an additional NPI on the enrollment |
| O20100930030085 | IL | DME Supplier - Pharmacy | 2860572856 | Practice locations: Chicago, IL |
Laboratory certificates & supplier records
Derived by NPIMapThese 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
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| CVS Pharmacy #04061 | 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 assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Highland Park CVS LLC
Organizations with this tax ID in the same state 15
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
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.
-
- Pharmacist
- Chicago, IL
- NPI 1023613973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1412726400000",
"number": "1972751014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE CVS DRIVE",
"address_2": "BOX 1075 - PHARMACY ENROLLMENTS",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "02895",
"telephone_number": "401-765-1500",
"fax_number": "401-770-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 S. STATE STREET",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60605",
"telephone_number": "312-697-0021"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HIGHLAND PARK CVS, L.L.C.",
"organizational_subpart": "NO",
"enumeration_date": "2008-09-03",
"last_updated": "2014-10-08",
"status": "A",
"authorized_official_last_name": "MAURICIO",
"authorized_official_first_name": "CRISTIANA",
"authorized_official_title_or_position": "MGR PHCY ENROLLMENTS",
"authorized_official_telephone_number": "401-765-1500"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "1482443",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmcay # 04061",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago, IL
- Highland Park CVS, L.L.C. (CVS Pharmacy # 04781)
- Highland Park CVS, L.L.C. (CVS Pharmacy 02981)
- Highland Park CVS, L.L.C. (CVS Pharmacy# 04793)
- Highland Park CVS, L.L.C. (CVS Pharmacy #03170)
- Highland Park CVS, L.L.C. (CVS Pharmacy # 02798)
- Highland Physical Therapy,PC
- Highlander Care Center, LLC (International Village)
- Delores D Highley-Lane, CADC, BA
- Highpoint Open MRI of Chicago, LLC
- Sharon Rose Highsmith, OTR/L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.