Green Tree Pharmacy – Pharmacy, NPI 1245221068
Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Green Tree Pharmacy
115, West Jefferson Street, Bloomington, McLean County, Illinois, 61701, United States
SUITE 401
BLOOMINGTON, IL 617013946
Phone: (309) 828-4361
Fax: (309) 829-9512
Type: Mailing
1305 N CAROLYN DR
MINONK, IL 617609326
Phone: (309) 432-3451
Fax: (309) 829-9512
Type: Mailing
1305, Carolyn Drive, Minonk, Woodford County, Illinois, 61760, United States
MINONK, IL 61760
Phone: (309) 432-3451
Fax: (309) 432-2575
Type: Location
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: 2021-02-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-02-28 (102 days ago).
Enrollment records
2
Earliest due date
2026-02-28
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 |
|---|---|---|---|---|
| O20120426000268 | O | Pharmacy | IL | TBD |
| O20210211003083 | O | Mass Immunization (Roster Biller Only) | IL | 2026-02-28 |
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 | 571 | 571 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 466 | 465 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 466 | 465 | $0 |
| 0124A | Adm sarscv2 bvl 30mcg/.3ml a | 411 | 408 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 397 | 397 | $0 |
Insurance plans in this area (ZIP 61701)
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