WALGREENS #02496 – Pharmacy, NPI 1124033444

WALGREENS #02496 is a healthcare provider. based in Burnsville, Minnesota. specializing in Pharmacy. The organization holds a License No. 260809 (MN). The NPI Number for WALGREENS #02496 is 1124033444

Main info

Organization
Name
WALGREENS #02496
NPI
1124033444
Phone
(952) 432-4471
Address
14700 LAC LAVON DR
Authorized Official
JENNIFER PONCE MANAGER
Enumeration Date
29 July 2006
Last Update Date
16 June 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness90
Years active:19State licenses:1Digital endpoints

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Provider Addresses for WALGREENS #02496

  • Walgreens, 14700, Lac Lavon Drive, Burnsville, Dakota County, Minnesota, 55306, United States

    BURNSVILLE, MN 553066398

    Phone: (952) 432-4471

    Type: Location

  • 1901, East Voorhees Street, Danville, Vermilion County, Illinois, 61832, United States

    MS 790

    DANVILLE, IL 618344509

    Phone: (847) 527-2489

    Fax: (217) 709-2344

    Type: Mailing

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 2025-07-31 (318 days ago).

Enrollment records

1

Earliest due date

2025-07-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20100930000807OPharmacyMN2025-07-31

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count896101$0
91320Sarscv2 vac 30mcg trs-suc im162162$0
90480Admn sarscov2 vacc 1 dose162162$0
G0008Administration of influenza virus vaccine132132$0
90662Influenza vaccine split virus, preservative free9191$0
View full utilization report →

Insurance plans in this area (ZIP 55306)

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Reviews

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Frequently asked questions

What number should I use to identify WALGREENS #02496 for billing?
Administrative and clinical systems typically use NPI 1124033444 for WALGREENS #02496.
Is WALGREENS #02496 currently accepting referrals based on NPI status?
Registry metadata lists WALGREENS #02496 as active.
How should patients interpret WALGREENS #02496's specialty?
The extract shows Pharmacy for WALGREENS #02496. Clinical services aligned with this taxonomy classification.
Which community is linked to WALGREENS #02496?
WALGREENS #02496 shows a connection to Burnsville, Minnesota in registry-derived data.
Can I export WALGREENS #02496's record?
You can download the official NPPES record; we summarize key fields for readability.

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