CMS-1500 Box 24J / 33a • NPI
1720759996
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
3336C0003X (CMS 58)
Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy
Box 32 Service Location & ZIP+4
114 S MAIN ST, GEORGETOWN, OH, 45121-1221
✓ 9-Digit EDI 837 ZIP+4 (45121-1221)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1720759996 (BERTRAM GEORGETOWN PHARMACY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1720759996)
Medicare Beneficiaries
41
Total Billed Services
104
Distinct CPT/HCPCS Codes
5
Medicare Allowed Total
$8,991.37
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
90480 | Admn sarscov2 vacc 1 dose | 39 |
91322 | Sarscov2 vac 50 mcg/0.5ml im | 39 |
G0008 | Administration of influenza virus vaccine | 13 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1720759996 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | BERTRAM GEORGETOWN PHARMACY |
| Plain-English Specialty | Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy NUCC Code: 3336C0003X (Pharmacy, Community/Retail Pharmacy) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 114 S MAIN ST, GEORGETOWN, OH, 45121-1221 |
| Practice Telephone / Fax | Tel: (937) 378-4844 | Fax: (937) 378-4226 |
| Administrative Mailing Address | 114 S MAIN ST, GEORGETOWN, OH, 45121-1221 |
| Enumeration & Last Sync | Enumerated: 2021-09-27 | CMS Record Updated: 2022-01-20 |
| Authorized Official | ALEXANDER BERTRAM (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in GEORGETOWN
🔒 Are you BERTRAM GEORGETOWN PHARMACY? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (3336C0003X)
What Does Taxonomy Code 3336C0003X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0003X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (BERTRAM GEORGETOWN PHARMACY)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
3336C0003X — Pharmacy, Community/Retail PharmacyPlain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.