Kroger Pharmacy #749 – Community/Retail Pharmacy, NPI 1154521060
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Kroger Pharmacy #749
22332, East 9 Mile Road, Saint Clair Shores, Macomb County, Michigan, 48080, United States
SAINT CLAIR SHORES, MI 480801972
Phone: (586) 541-1042
Fax: (586) 541-1044
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
22801 HARPER AVE
ST. CLAIR SHORES, MI 48080
Phone: (586) 800-5190
Fax: (586) 800-5195
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 2024-09-30 (621 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 |
|---|---|---|---|---|
| O20100930099518 | O | Pharmacy | MI | 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 |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 454 | 46 | $0 |
| G0008 | Administration of influenza virus vaccine | 95 | 95 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 88 | 88 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 73 | 73 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 64 | 64 | $0 |
Insurance plans in this area (ZIP 48080)
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