NPIMap

Organization Active NPI

C R Pharmacy Service Inc

Doing business as Kelly's Home Medical, a CarePro Affiliate

  • Oxygen Equipment & Supplies (DME)
  • Davenport, IA
National Provider Identifier
1992126551
Registry record updated Jul 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
Legal business name
C R PHARMACY SERVICE INC
Doing business as
Kelly's Home Medical, a CarePro Affiliate
Practice address
730 E Kimberly Rd
Davenport, IA 52807-1621
Phone
(563) 386-1553
Fax
(563) 391-7702
NPI assigned
Dec 30, 2013
Last updated
Jul 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2015

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

Authorized official

Name
Mrs. Michelle M. Jensen
Title
Ceo
Phone
(319) 363-4554

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X NU Primary

Addresses

Primary practice location

730 E Kimberly Rd
Davenport, IA 52807-1621

Mailing address

730 E Kimberly Rd
Davenport, IA 52807-1621
Phone (563) 386-1553

Other names 1

  • Kelly's Home Medical, a CarePro Affiliate Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140204001442 IA DME Supplier - Medical Supply CompanyDME Supplier - Orthotic PersonnelDME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 9234022260 Practice locations: Davenport, IA

Other NPIs with the same Medicare PAC ID 2

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

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
Kelly's Home Medical, a Carepro Aff730 East Kimberly Road, Davenport, IA 52807-1621(563) 386-1553 Commodes, Urinals, Bedpans|Continuous Passive Motion (CPM) Devices|Blood Glucose Monitors/Supplies (Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Negative Pressure Wound Therapy Pumps/Supplies|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Ultraviolet Ligh… Does not accept assignmentParticipating since Jan 1, 2017

National Provider Directory

National Provider Directory
Tax ID family
C R Pharmacy Service Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1388361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438300800000",
    "number": "1992126551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 E KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071621",
            "telephone_number": "563-386-1553",
            "fax_number": "563-391-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 E KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528071621",
            "telephone_number": "563-386-1553",
            "fax_number": "563-391-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C R PHARMACY SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-30",
        "last_updated": "2015-07-31",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-363-4554",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kelly's Home Medical, a CarePro Affiliate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; 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.