SUPER G PHARMACY 387 – Community/Retail Pharmacy, NPI 1184657439
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SUPER G PHARMACY 387
1000, Northeast 178th Avenue, Rockwood, Portland, Metro, Multnomah County, Oregon, 97230, United States
MS 3000
PORTLAND, ME 041045005
Phone: (207) 885-7454
Fax: (704) 645-6531
Type: Mailing
Giant, 19312, Lighthouse Plaza Boulevard, Beachfield, Camelot Mobile Home Park, Rehoboth Beach, Sussex County, Delaware, 19971, United States
REHOBOTH BEACH, DE 19971
Phone: (302) 227-5954
Fax: (302) 226-6190
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: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2026-03-31 (73 days ago).
Enrollment records
2
Earliest due date
2026-03-31
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 |
|---|---|---|---|---|
| O20080916000625 | O | Centralized Flu Biller | TX | 2026-03-31 |
| O20100930017061 | O | Pharmacy | DE | TBD |
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 | 599 | 598 | $0 |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 542 | 62 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 433 | 433 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 331 | 331 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 279 | 279 | $0 |
Insurance plans in this area (ZIP 04104)
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