KROGER PHARMACY – Community/Retail Pharmacy, NPI 1235163049
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for KROGER PHARMACY
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
Tractor Supply Company, 601, North Commercial Street, Harrisburg, Saline County, Illinois, 62946, United States
HARRISBURG, IL 629463327
Phone: (618) 252-8691
Fax: (618) 252-7602
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)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
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 |
|---|---|---|---|---|
| O20100930015509 | O | Pharmacy | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 | 157 | 156 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 148 | 147 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 131 | 131 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 125 | 125 | $0 |
| 0124A | Adm sarscv2 bvl 30mcg/.3ml a | 17 | 17 | $0 |
Insurance plans in this area (ZIP 02284)
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