MEDI-MART PHARMACY
NPI 1659374379
Pharmacy - Long Term Care Pharmacy in San Angelo, TX
NPI Status: Active since May 27, 2005
Contact Information
2102 PECOS ST
STE 13
SAN ANGELO, TX
ZIP 76901
Phone: (325) 949-5381
Fax: (325) 942-9997
- Organization
- Pharmacy
- Long Term Care Pharmacy
- Accepts Insurance
- Medicare Supplier
- Does Not Accept Medicare Approved Payment
- CLIA Number: 45D2153699
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-28-2026
About MEDI-MART PHARMACY
This page provides the complete NPI Profile along with additional information for Medi-mart Pharmacy, a provider established in San Angelo, Texas operating as a Pharmacy, focusing in long term care pharmacy . The healthcare provider is registered in the NPI registry with number 1659374379 assigned on May 2005. The practitioner's primary taxonomy code is 3336L0003X with license number 13819 (TX). The provider is registered as an organization and their NPI record was last updated 7 years ago. The provider's is doing business as Medi-mart Pharmacy. The authorized official of this NPI record is Bryan T Abernathy (President)
- NPI
- 1659374379
- Provider Legal Name
- PECOS STREET PHARMACY, INC.
- Other Organization Name
- MEDI-MART PHARMACY
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 2102 PECOS ST STE 13 SAN ANGELO, TX 76901
- Location Phone
- (325) 949-5381
- Location Fax
- (325) 942-9997
- Mailing Address
- 2102 PECOS ST SAN ANGELO, TX 76901
- Mailing Phone
- (325) 949-5381
- Mailing Fax
- (325) 942-9997
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-27-2005
- Last Update Date
- 07-11-2019
- Code Navigator
Medi-mart Pharmacy is a medicare supplier with PTAN 20656847 who does not accept Medicare assignment for all durable medical equipment and supplies. The provider may not accept the Medicare allowable as payment in full and may collect additional payment directly from the patient, and/or charge more than the Medicare allowable.The supplier carries the following product categories: Immunosuppressive Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Commodes, Urinals, Bedpans or Blood Glucose Monitors/Supplies (Non-Mail Order) or Canes and/or Crutches or Walkers or Ostomy Supplies or Urological Supplies or Nebulizer Equipment and/or Supplies or Diabetic Shoes and Inserts.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pharmacy Long Term Care Pharmacy
- Taxonomy Code
- 3336L0003X
- Type
- Suppliers
- License No.
- 13819
- License State
- TX
- Taxonomy Description
- A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 333600000X | Suppliers | Pharmacy | 13819 (TX) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Select by Medica Bronze $0 Copay PCP Visits - EPO
- Select by Medica Bronze Share - EPO
- Select by Medica Expanded Bronze Standard - EPO
- Select by Medica Gold $0 Copay PCP Visits - EPO
- Select by Medica Gold Share - EPO
- Select by Medica Gold Standard - EPO
- Select by Medica Silver $0 Copay PCP Visits - EPO
- Select by Medica Silver Share - EPO
- Select by Medica Silver Standard - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 4586307 | OTHER (01) | TX | NABP NUMBER |
| 350004 | MEDICAID (05) | TX |
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20656847
- Accepts Medicare Assignment
- NO
- Specialities List
- Certified Other, Pharmacy.
- Competitive Bidding
- NO
Supplies List
- Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
- Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
- Oral Anticancer Drugs - FDA anticancer drugs
- Oral Antiemetic Drugs - FDA antiemetic drugs
- Commodes, Urinals, Bedpans - Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
- Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
- Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
- Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
- Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
- Urological Supplies - Catheters, Urinary collection devices
- Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
- Diabetic Shoes and Inserts - Shoes, Socks, Insoles
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D2153699
- Facility Type
- Physician Office
- Certificate Effective Date
- August 29, 2024
- Certificate Expiration Date
- August 28, 2026
- Laboratory Director
- BRYAN T. ABERNATHY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Medi-mart Pharmacy to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1659374379, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 71. The final step is to find the difference between that total and the next multiple of ten (80 - 71 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 71 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 5 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1659374379, enumerated as an "organization" on May 27, 2005.
The provider is located at 2102 PECOS ST STE 13 SAN ANGELO, TX 76901 and the phone number is (325) 949-5381.
Pharmacy with taxonomy code 3336L0003X and a focus in Long Term Care Pharmacy.
The provider might be accepting Accepts: Medica, Moda Health Plan, Inc., Medicare and. Please consult your insurance carrier or call the provider to verify.
