The Medicine Shoppe – Community/Retail Pharmacy, NPI 1417923012
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for The Medicine Shoppe
2339, Broadway Street, Mount Vernon, Jefferson County, Illinois, 62864, United States
MOUNT VERNON, IL 628642925
Phone: (618) 242-8776
Mailing address matches the actual address.
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: 2012-03-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1018 days ago).
Enrollment records
2
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20100930038571 | O | Pharmacy | IL | 2026-06-30 |
| O20120313000643 | O | Mass Immunization (Roster Biller Only) | IL | 2023-08-31 |
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 | 166 | 166 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 141 | 141 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 52 | 52 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 52 | 52 | $0 |
| G0009 | Administration of pneumococcal vaccine | 18 | 18 | $0 |
Insurance plans in this area (ZIP 62864)
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