NPIMap

Organization Active NPI

Dean Retail Services, Inc.

  • Community/Retail Pharmacy
  • Janesville, WI
National Provider Identifier
1992815682
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
DEAN RETAIL SERVICES, INC.
Practice address
3200 East Racine Street
Suite 300
Janesville, WI 53546-2343
Phone
(608) 371-8100
Fax
(608) 371-8105
NPI assigned
Aug 30, 2006
Organization subpart
Yes
Parent organization
DEAN HEALTH SYSTEMS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Amy Jo Grinnell
Title
VP Finance
Phone
(608) 260-3586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

3200 East Racine Street
Suite 300
Janesville, WI 53546-2343

Mailing address

P.O Box 259443
Attn: SSM Health Pharmacy Admin
Madison, WI 53725-9443
Phone (608) 250-1450

Other identifiers 1

IdentifierTypeStateIssuer
33205500MedicaidWI

Other names 1

  • SSM Health Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930096726 WI DME Supplier - Pharmacy 5395863773 Practice locations: Janesville, WI
O20130614000506 WI Part B Supplier - Mass Immunization (Roster Biller Only) 5395863773 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Madison, WI; Janesville, WI

Other NPIs with the same Medicare PAC ID 20

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

View all 20

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Dean Optical21 organizations share this tax ID, including this one
Part of
Dean Medical Ctr - Beav

Other organizations with this tax ID 20

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

View all 20

Locations

3200 E Racine St
Ste 300
Janesville, WI 53546
Phone (608) 371-8100

1277 Deming Way
Madison, WI 53717
Phone (608) 827-4440

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1992815682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX 259443",
            "address_2": "ATTN: SSM HEALTH PHARMACY ADMIN",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537259443",
            "telephone_number": "608-250-1450",
            "fax_number": "608-824-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 EAST RACINE STREET",
            "address_2": "SUITE 300",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535462343",
            "telephone_number": "608-371-8100",
            "fax_number": "608-371-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN RETAIL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEAN HEALTH SYSTEMS, INC.",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "GRINNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33205500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.

Verify at the official NPI Registry.