KROGER PHARMACY – Community/Retail Pharmacy, NPI 1407880230
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KROGER PHARMACY
203 COMMERCE AVE STE A
LAGRANGE, GA 302412358
Phone: (706) 883-6178
Fax: (706) 885-0487
Type: Location
PO Box 846028, Albany Street, Church Green, Financial District, Boston, Suffolk County, Massachusetts, 02284-6028, United States
BOSTON, MA 022842772
Phone: (513) 762-1019
Fax: (513) 762-1092
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-09-30 (620 days ago).
Enrollment records
1
Earliest due date
2024-09-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20100930026182 | O | Pharmacy | GA | 2024-09-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0008 | Administration of influenza virus vaccine | 112 | 111 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 108 | 108 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 55 | 55 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 34 | 34 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 21 | 21 | $0 |
Insurance plans in this area (ZIP 30241)
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