Mt Vernon Community Pharmacy Inc
NPI 1417923012 · Community/Retail Pharmacy · Mount Vernon, IL
Enrolled with Medicare as Dme Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Mt Vernon Community Pharmacy Inc is a Community/Retail Pharmacy organization in Mount Vernon, IL (NPI 1417923012).
Provider details
- NPI number
- 1417923012
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Eric Black, Owner(618) 242-8776
- License
- 054016737 (IL)
Specialties & taxonomies
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
20 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
326 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Administration of Influenza Virus VaccineG0008 | 207 | $30 |
| Admn Sarscov2 Vacc 1 Dose90480 | 106 | $42 |
| Administration of Pneumococcal VaccineG0009 | 13 | $31 |
Typical Medicare-allowed amounts for these services range $30–$42 (2024). The Medicare-allowed amount is what Medicare recognizes for a service under fee-for-service — a reference figure for 2024, not a price quote and not what you would be billed. Medicare Part B covers roughly an eighth of all NPIs (65+ skew); services with fewer than 11 beneficiaries are suppressed by CMS. Source: CMS Medicare Physician & Other Practitioners, by Provider & Service.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- The Medicine Shoppe
Registry dates
- Enumerated
- 2006-02-24
- Last updated
- 2011-11-01
Frequently asked questions
- What is Mt Vernon Community Pharmacy Inc's NPI number?
- Mt Vernon Community Pharmacy Inc's National Provider Identifier (NPI) is 1417923012, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mt Vernon Community Pharmacy Inc?
- Mt Vernon Community Pharmacy Inc is classified in the NPPES registry as Community/Retail Pharmacy (Suppliers).
- Where is Mt Vernon Community Pharmacy Inc located?
- Mt Vernon Community Pharmacy Inc's practice location on file with NPPES is 2339 Broadway St, Mount Vernon, IL 62864-2925.
- What is Mt Vernon Community Pharmacy Inc's phone number?
- The practice phone number listed in the NPPES registry for Mt Vernon Community Pharmacy Inc is (618) 242-8776.
- Does Mt Vernon Community Pharmacy Inc accept Medicare?
- Mt Vernon Community Pharmacy Inc is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Mt Vernon Community Pharmacy Inc?
- The authorized official listed on Mt Vernon Community Pharmacy Inc's NPPES record is Eric Black, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mt Vernon Community Pharmacy Inc's NPI active?
- Yes — Mt Vernon Community Pharmacy Inc's NPI (1417923012) is active in the NPPES registry as of the last update on 2011-11-01.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.